Partnership With a Graduate Nursing Program: Voices of the Community

Transcription

1 Universiy of Nebraska Omaha Disseraion and Thesis Barbara A. Holland Collecion for Service Learning and Communiy Engagemen (SLCE) 2003 Parnership Wih a Graduae Nursing Program: Voices of he Communiy Deborah Essex Forbes Lindell Case Wesern Reserve Universiy Follow his and addiional works a: hp://digialcommons.unomaha.edu/slced Par of he Service Learning Commons Recommended Ciaion Lindell, Deborah Essex Forbes, "Parnership Wih a Graduae Nursing Program: Voices of he Communiy" (2003). Disseraion and Thesis. Paper 36. hp://digialcommons.unomaha.edu/slced/36 This Thesis is brough o you for free and open access by he Barbara A. Holland Collecion for Service Learning and Communiy Engagemen (SLCE) a DigialCommons@UNO. I has been acceped for inclusion in Disseraion and Thesis by an auhorized adminisraor of DigialCommons@UNO. For more informaion, please conac unodigialcommons@unomaha.edu.

2 PARTNERSHIP WITH A GRADUATE NURSING PROGRAM: VOICES OF THE COMMUNITY A Thesis Presened o he Faculy ofhe Frances Payne Bolon School ofnursing Case Wesern Reserve Universiy In parial fulfillmen ofhe requiremens For he Degree ofdocor of Nursing by DEBORAH ESSEX FORBES LINDELL BSN, MSN, APRN,BC Approved: _--'- Member

3 ~ I I ~ I ABSTRACT Academic-communiy parnerships (ACPs) are a means by which communiy-based organizaions can implemen heir missions and programs of higher educaion can faciliae suden educaional objecives hrough real world learning experiences. Many ACPs are framed in he educaional mehodology, service-learning. Theoreical definiions of ACPs (as a ype of iner-organizaional relaionship) describe hem as relaionships ha are on-going, reciprocal and characerized by muual rus and respec. During he pas 15 years, ACPs and service-learning have experienced a rapid growh in nursing educaion. Lieraure peraining o ACPs in nursing educaion is largely anecdoal and concerns undergraduae nursing programs. There are few repors of research peraining o ACPs, paricularly hose involving graduae nursing programs or communiy parners' perspecives of heir experiences in ACPs. The purpose of his sudy was o explore communiy parners' perspecives of parnership wih a graduae nursing program. The grounded heory approach o qualiaive research was used o answer research quesions concerning he process of, and facors influencing, he parnerships. The seing for he sudy was 17 organizaions ha have parnered wih a graduae program of nursing as par of a projec called, Communiy Engagemen Through Service- Learning. Thireen key conac persons from each parnership were each inerviewed once. Addiional daa collecion mehods included field noes, a group meeing and member checking. Thireen paricipans represening 14 parnerships paricipaed in he sudy. Daa analysis began wih he iniial inerview. Techniques included open coding, consan NSLC c/o ETR Associaes 4 Carbonero Way Scos Valley, CA 95066

4 ii comparison, he Six C's family of codes and memoing. Phases of daa analysis included: Level I (Level I, II and III coding), Phase II (delimiing he heory) and Phase III (wriing he heory). Acceped sraegies o promoe rigor were also employed: wo rounds of member I I I ~ I I I I I I I I I checking, peer review and mainaining an audi rail. Twelve paricipans repored posiive oucomes and saisfacion wih he relaionship. Nine had engaged in parnerships wih one faculy member for one semeser. Four had parnered wih one faculy member for wo o four semesers. Producs of daa analysis included: a summary of each inerview, 20 caegories, six conceps, and wo consrucs along wih heir associaed properies; he basic social process i.e., Connecing for Parnership and a subsanive, descripive heory. The parnerships in his sample were seen as being of wo levels. Level I, Teaming, refers o he process, a sequence of five sages, which occurs over he course of one semeser. Facors relevan o each sage were idenified and include: commimen by all involved; a close, working relaionship; consideraion of each oher's culure; horough, effecive communicaion, and careful planning. Primary and secondary oucomes were idenified for boh paricipans and sudens. Level II, Susaining, refers o on-going parnerships characerized by coninuing commimen, shared goals, building on evaluaion findings and muual rus and respec. The findings of his sudy suppored he lieraure and idenified several facors specific o parnerships wih a graduae nursing program. Advanages and challenges unique o working wih MSN sudens were discussed. Implicaions for direc relevance and ransferabiliy for professional nursing and oher disciplines were described. Limiaions relaed primarily o he use of grounded heory mehods and direcions for fuure quaniaive and qualiaive research were idenified.

5 ~ ~ iii I I Copyrigh 2003 Deborah Essex Forbes Lindell BSN, MSN, APRN,BC

6 IV I I I I I I I I I I I I I I I I I I I I I I I RULES GOVERNING USE OF THESES FROM THE FRANCES PAYNE BOLTON SCHOOL OF NURSING, CASE WESTERN RESERVE UNIVERSITY Unpublished heses or research repors submied o he Frances Payne Bolon School of Nursing Case Wesern Reserve Universiy, and deposied in he Library, are open for inspecion, bu are o be used wih due regard o he righs ofhe auhors. The auhor and he School ofnursing gran he privilege ofloan or purchase of microfilm or phoocopy o accredied borrowers provided proper credi is given in subsequen wrien or published work. Auhor Dean, School ofnursing Deborah F. Lindell Souh Roundhead Dr. Solon, Ohio Dae: I I

7 DEDICATION v This Docor of Nursing hesis is dedicaed o my husband, Craig, and o my children, Andrew, Carolyn, and Sarah, for heir love, suppor and encouragemen hroughou his journey o achieve my dream of so many years. I couldn' have done i wihou you! I is also dedicaed o my parens, Rober and Olwen Forbes, for eaching me he value ofa lifelong pursui of knowledge and undersanding. ACKNOWLEDGMENTS The auhor wishes o acknowledge he menoring, wisdom, experise, encouragemen and suppor provided by her commiee chair, Dr. Theresa Sanding, as well as her commiee members: Dr. Marion Krainess, Dr. Georgia Narsavage, and Glenn Odenbre. In heir own way, each played a criical role in he auhor's developmen as a scholar, educaor and Clinical Nurse Specialis in Communiy Healh Nursing; commimen o service-learning and communiy-academic parnerships; and successful compleion ofhe Docor ofnursing degree. The auhor also acknowledges he paricipans in her sudy. These 13 very busy individuals willingly suppored he educaion of advanced pracice nurses and sough o mee he needs of heir organizaions and cliens when hey conneced wih faculy and sudens ofhe Bolon School's MSN program. Beyond ha, and wihou hesiaion, hey ook he ime o me wih me and share heir experiences wih hose connecions. Deborah Forbes Lindell, July 2003 I I

8 vii Chaper IV Resuls Inroducion Resuls of Level I Coding Resuls of Level II Coding Research Quesion 1 Research Quesion 2 Resuls of Level III Coding Phase II: De-limiing he Theory Phase III: Wriing he Theory Connecing for Parnership (Theory) Summary Chaper V Discussion Inroducion Inerpreaion Conclusions Implicaions for Nursing Limiaions Direcions for Fuure Research Summary References Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix F Appendix G Wingspread Principles of Good Pracice for Combining Service and Learning CCPH Principles of Parnerships Benchmarks for Campus-Communiy Parnerships Tool- Feedback from Communiy Parners Applicaion for CWRU Insiuional Review Board Review CWRU Insiuional Review Board Approval Summaries ofinerviews Final Summary

9 viii, Lis of Tables Page I Table 1 Transacional and Transfonnaive Relaionships 50 Table 2 Descripion of Paricipans 80 Table 3 Example of Daa Analysis 88 I Table 4 Six C's Coding Family 90 I Table 5 Level II Codes 100 Table 6 Facors Influencing he Parnerships 120 I Table 7 Level III Codes 127 I Table 8 Connec for Parnership: Caegories, Conceps, and Consrucs 134 I Table 9 Comparison of Sages of Communiy-Academic Parnerships 142 I I I I

10 1 I I I I SERVICE-LEARNING WITH A GRADUATE NURSING PROGRAM: VOICES OF THE COMMUNITY Chaper I Inroducion The purpose of his grounded heory sudy was o examine he perspecives of communiy organizaions (COs) regarding he process of parnership wih a graduae nursing educaion program. The heoreical underpinnings were derived from Cruz and Giles' (2000) approach o examinaion of communiy perspecives of service-learning and Gelmon, Holland, Driscoll, Spring, and Kerrigan's (2001) model for assessmen of service-learning. Mehodological underpinnings of he sudy were based on Glaser and Srauss' Discovery of Grounded Theory mehod of qualiaive research (1967). Daa collecion mehods included semi-srucured inerviews wih parner COs, field observaion, and review of lieraure as indicaed. The following discussion will address he problem saemen, purpose, quesions, nursing. erms, heoreical and mehodological underpinnings, assumpions, and significance for I I I I Background The Needfor Iner-agency Collaboraion In recen years, COs concerned wih promoing he healh of populaions and communiies have faced increasingly limied financial and human resources while a he same ime calls by naional leaders and funding agencies for iner-disciplinary and iner-agency collaboraion (Deparmen of Healh and Human Services, 2000). One response by hese

11 2 organizaions has been uilizaion of collaboraion wih oher organizaions in order o accomplish heir missions and goals (Pilo Sudy paricipans A, B, and C, personal communicaion, 2002). The concep ofiner-agency collaboraion for communiy healh has been frequenly sudied as o boh oucomes and process. Several frameworks have been published which describe facors influencing iner-agency collaboraion and research has examined he exen of collaboraion among agencies. Examples include Prolivka, 1996; Sco and Thurson, 1997; and Lasker, Weiss, and Miller, Alhough he seings and influencing facors varied from sudy o sudy, facors common o all included: muual respec and rus among parners; shared aims; and clear, coninuous communicaion. The models and research findings referred o above are discussed in deail in Chaper II and, using Glaser and Srauss' approach o developmen ofgrounded heory, were re- considered during he daa analysis phase of his projec Academic-Communiy Parnerships Programs of healh professions educaion, including graduae nursing educaion, have been called upon o provide increased suden learning experiences geared oward populaionfocused, healh promoion and disease prevenion in communiy-based, iner-disciplinary seings and o promoe suden commimen o civic engagemen (Pew Healh Professions Commission, 1998; American Associaion of Colleges ofnursing, 1999; and Baisoni, 2001). Academic-communiy parnerships (ACPs) and service-learning are innovaive sraegies by which COs and programs of graduae nursing can respond o hese challenges. ACPs allow COs o uilize communiy asses o build communiy capial, enhance he qualiy and quaniy ofheir services, and improve he healh ofheir cliens and communiy (Krezmann and McKnigh, 1993 and Hancock, 2001). For programs ofgraduae nursing a a

12 I I I I I I I I I I I 3 educaion, ACPs offer a means o implemen service-learning, provide "real-life" experiences in iner-disciplinary, communiy based seings and promoe suden appreciaion of he value of communiy service. Service-learning, an educaional mehodology wih roos in experienial educaion, appeared in he lieraure in he lae 1970's (Sigmon, 1979). Is inegraion in higher educaion dramaically increased during he mid-1980's. Sigmon (1979) suggesed hree principles for service-learning and basic guidelines for heir implemenaion. In he lae 1980's, a group of early leaders in service-learning me a Wingspread o develop a research agenda and he Principles for Good Pracice for Combining Service and Learning (Wingspread Principles) (Honne and Poulson, 1988). The en principles emphasize reciprociy beween he academic and communiy parners, programs designed o mee communiy needs, and muual planning and evaluaion (Honne and Poulson, 1988). The service-learning movemen spread o healh professions educaion during he 1990's. Communiy-Campus Parnerships for Healh (CCPH), a naional organizaion founded in 1996 o foser collaboraion among academic and communiy-based organizaions, has been a srong leader. CCPH ariculaed nine principles "o help faciliae and srenghen parnerships beween communiies and higher educaional insiuions" (Seifer and Maurana, 2000, p. 7). Exemplary parnerships were described as reciprocal, collaboraive relaionships guided by "muually agreed-upon mission, values, goals and measurable oucomes" (Seifer and Maurana, 2000, p. 7). The Sigmon (1979), Wingspread (Honne and Pauson, 1988), and CCPH (2000) principles may be congruen wih facors influencing iner-agency collaboraion. As inegraion of service-learning has expanded ino he academic disciplines, leaders in he movemen have coninued o sugges direcions for fuure research (Howard, Gelmon,

13 I I a I and Giles, 2000). One direcion idenified in 1991, 1997, and again in 2000 is he need o move beyond sudy of he impac of service-learning on sudens o addressing he perspecives of muliple sakeholders, including communiy parners and heir cliens. However, unlike research in he broader field of iner-agency collaboraion, service-learning research has focused heavily on he academic process and oucomes (Cruz and Giles, 2000). The clear need for service-learning research geared o he communiy perspecive is examined in his sudy in erms of graduae nursing educaion. In he nex four secions, he 4 reader will find an overview of he sae ofcurren research regarding he communiy perspecive of service-learning examined, in increasingly narrow scope, from he general area of higher educaion o he specific area of his sudy, graduae nursing educaion. Higher Educaion (Excluding Healh Professions Educaion) special issue, Sraegic Direcions for Service-Learning Research. In heir aricle, "Where's he Communiy in Service-Learning Research?", Cruz and Giles (2000) repored heir meaanalysis of available lieraure on he opic. They noed he lack ofexising models for, and In Fall, 2000, The Michigan Journal ofcommuniy Service-Learning published a In developed rigorous research designed o examine, he communiy parner's perspecive. In calling for scholarly work o address his gap, Cruz and Giles (2000) emphasized he imporance of incorporaing he key service-learning principle of reciprociy beween parners and proposed a four-par model for assessing communiy parners' perspecives of service-learning. 200 I, Gelmon, Holland, Driscoll, Spring, and Kerrigan published heir handbook Assessing Service-Learning and Civic Engagemen. The assessmen model was based on ha o evaluae he Healh Professions Schools in Service o he Naion (HPSISN) and several oher large-scale service-learning projecs. The imporance ofa muli-consiuency

14 5 I approach, including communiy parners, o assessmen of service-learning was again emphasized. Healh Professions Educaion (Excluding Nursing Educaion). muli-sie In 1998, Gelmon e al. published he final evaluaion repor of he naional demonsraion projec, Healh Professions Schools In Service To The Naion (HPSISN). The auhors sressed he imporance of a muli-consiuency approach o assessmen ha included communiy parner agencies and repored heir findings of feedback from communiy parners (Gelmon e ai., 1998). lieraure, In 2001, Wolff and Maurana noed several sudies had examined facors influencing ACPs from he academic perspecive bu here was a lack of knowledge abou he communiy parner's perspecive. They repored findings ofheir sudy of communiy parners' perspecives of ACPs involving academic healh ceners. Undergraduae Nursing Educaion Undergraduae nursing was early o embrace service-learning and many faculy have published repors of experiences. A comprehensive examinaion of available, published lieraure revealed 22 aricles and one book on ACPs and service-learning in nursing (Noe: he aricles and book are indicaed in he References wih a "*"). Like he higher educaion I educaion were largely anecdoal and described he auhors' experiences in one or a few courses. Six of he publicaions repored research sudies of varying rigor (Hales, 1997; repors ofexperiences wih service-learning and ACPs in undergraduae nursing Simoni and McKinney, 1998; Schneiderman, Jordan-Marsh, and Baes-Jensen, 1998; Whie, Fesa, Allocca, and Abraham, 1999; Peersen and Schaeffer, 1999; and Schaeffer, Maher, and Gusafson, 2000). Alhough many aricles had muliple auhors, only wo were co

15 auhored 6 I I by boh a faculy member and a communiy parner (Schaffer, e ai., 2000 and Corbe, Seer, and Rappuchi, 2000). The remainder was auhored only by faculy. A number ofaricles acknowledged he principles of exemplary service-learning and ACPs. However, he nursing lieraure clearly focused on he academic process and suden oucomes. Several repors made no menion offeedback from he communiy parner (Hales, mehods 1998; 1997; Calliser and Hobbins-Garbe, 2000; Simoni and McKinney, 1998). The remaining repors menioned benefis o he communiy parner; however, jus four discussed heir (Schneiderman, e ai., 1998; Peersen and Schaeffer, 1999; Bailey, Carpener, and Harringon, 1999; Whie, e ai., 1999). Graduae Nursing Educaion Six publicaions were found ha repored experiences of graduae nursing educaion wih ACPs and service-learning (Logsdon and Ford, 1998; Horak, O'Leary, and Carlson, I 2003) Scheideberg, 1999; Luz, Herrick, and Lehman, 2001; Cohen and Milone-Nuzzo, 2001; and Narsavage, Lindell, Chen, Savrin, and Duffy, 2003). One ofhe six (Narsavage e. ai, repored findings ofa research sudy designed o examine a program-wide experience. Analysis ofhe graduae nursing lieraure paralleled ha of undergraduae nursing as o: use of a service-learning framework and focus on he academic perspecive. Jus hree of he I graduae nursing aricles repored feedback from he communiy parner/s and one indicaed mehods used. Problem Saemen Hallmarks of successful, exemplary service-learning pracice and academiccommuniy parnerships include reciprociy; muual rus and respec; shared aims; aciviies designed o mee communiy-idenified needs; clear, coninuous communicaion; and beneficial oucomes for boh parners. There is a growing body of lieraure in higher

16 I, I I I I I I I I 7 educaion, including graduae and undergraduae nursing as well as oher healh disciplines, ha documens processes and posiive oucomes for academic parners. A few models of communiy parnerships and assessmen of service-learning have been described. However, heory developmen and research concerning he perspecive of communiy parners' is lacking a all levels of higher educaion and graduae nursing educaion in paricular. Much of he limied informaion available is anecdoal in naure and one canno assume i has relevance for service-learning and ACPs involving graduae nursing educaion. Graduae sudens in nursing have specific learning needs and bring unique professional skills and life experiences o parnership wih a CO ha are very differen from hose of undergraduae nursing sudens or sudens ofoher disciplines. I canno be assumed ha he few available frameworks have relevance for ACPs and service-learning in graduae nursing educaion. As Glaser and Srauss noed in heir book, The Discovery o/grounded Theory, Subsanive heory faihful o he empirical siuaion canno, we believe, be formulaed merely by applying a few ideas from an esablished formal heory o he subsanive area. To be sure one goes ou and sudies an area wih a paricular... perspecive, and wih a focus, a general quesion, or a problem in mind. Bu he can (and we believe should) also sudy an area wihou a preconceived heory ha dicaes, prior o he research, "relevancies" in conceps and hypoheses (Glaser and Srauss, 1967, p. 33). Purpose Furher research and heory developmen was needed concerning communiy parner's perspecives of paricipaion in ACPs involving graduae nursing educaion. The purpose ofhe sudy was o conribue o meeing his need by examining communiy healh

17 I I I I I I I graduae 8 organizaions' perspecives as o he process of paricipaion in academic-communiy healh parnerships involving graduae nursing educaion. Research Quesions This sudy sough o answer he following quesions: 1. How do communiy organizaions describe he process of paricipaion in an academic-communiy parnership wih a graduae nursing program? 2. Wha facors do communiy organizaions idenify as influencing parnership wih a nursing program? Definiions o/terms 1. Communiy organizaion (CO) A communiy-based organizaion ha has an ineres in promoion ofcommuniy healh and prevenion ofdisease. These effors may be primary (conribuing direcly o he organizaion's mission) or secondary (creaing condiions which faciliae achieving he organizaion's mission). Examples ofcos include: volunary healh and human service organizaions, governmenal agencies (healh and human service, police, fire/rescue, and jails), houses of faih, museums, and educaional insiuions such as pre-school and kindergaren -grade 12. I I I 2. Parnership: "A close muual cooperaion beween paries having common ineress, responsibiliies, privileges and power" (Communiy-Campus Parnerships for Healh, 2001). 3. Academic-communiy parnership (ACP) - A working relaionship of one program or course in higher educaion and one CO conduced wihin he framework of service learning and in which each parner benefis from he arrangemen. Collaboraion and parnership are considered o be synonymous (adaped from Rohman, 1998, p. 202).

18 4. Service-Learning service-learning is "a srucured learning experience ha 9 I reflecion. Sudens paricipaing in service-learning aciviies are no only expeced o provide direc communiy service bu also o learn abou he conex in which he combines communiy service wih explici learning objecives, preparaion and academic course work" (Connors and Seifer, 1997, p. 13). service is provided, and undersand he connecion beween he service and heir Theoreical Underpinnings I The heoreical underpinnings for he sudy were derived from he perspecives of research in service-learning and ineragency collaboraion for communiy healh. The design of he sudy was no shaped around a paricular concepual framework as: (a) no framework ~ specific o academic-communiy healh parnerships has been proposed and (b) he purpose of grounded heory research is no o verify an exising heory bu o generae a subsanive heory based on he sudy findings. Concepual frameworks ha may have relevance o his sudy are briefly presened below and discussed in more deail in Chaper II. Ineragency Collaboraion/or Communiy Healh I Considerable heory developmen and research has been done in he area of ineragency collaboraion for communiy healh. Three concepual frameworks of ineragency I I I I collaboraion were assessed as o heir relevance o he sudy: Prolivka's (1996) Concepual Framework for Ineragency Collaboraion, Sco and Thurson's Framework for he Developmen of Communiy Healh Agency Parnerships (1997); and Lasker, Weiss, and Miller's (2001) Framework for Parnership Synergy. Each esed he model a leas once. The parnerships examined varied widely among he sudies as o purpose, srucure, number of parners, and duraion. Alhough here are some differences among he models as o facors found o influence ineragency collaboraion for communiy healh, here are also several

19 .. similariies: a I I assessmen I inegraed 10 a common goal, plan and srucure agreed upon by all parners; a reciprocal relaionship wih muual rus and respec; coninuous, effecive communicaion; and program evaluaion. These facors are congruen wih he principles of parnership referred o earlier. The models and heir associaed research as well as an addiional research sudy are discussed in deph in Chaper II. Service-Learning Few concepual frameworks for design, implemenaion and assessmen of servicelearning and ACPs have been described in he lieraure and none were found specific o service-learning and ACPs in graduae nursing educaion or undergraduae nursing educaion. Cruz and Giles (2000) noed he lack of rigorous service-learning research on he communiy perspecive of service-learning and suggesed he reasons were "complex wih poliical, inellecual and pracical dimensions" (p. 28). Their proposed model addresses his issue by: (a) making he parnership he uni of analysis, (b) focusing on asses, (c) incorporaing he principles of service-learning and (d) using mehods of acion research. Cruz and Giles cie wo examples of effors incorporaing hese elemens: Gelmon e al. 's model and he 3-1 Model being revised and esed a Vanderbil Universiy by Melinda Clark. The Cruz and Giles' (2000) model and he model and deailed procedures repored by Gelmon e al. (2001) are discussed in furher deail in Chaper II and elemens of boh were ino he design and implemenaion (consan comparaive analysis and heoreical sampling) ofhe sudy. Jensen and Royeen (2001) described heir experience wih heir adapaion ofhe "Inegraion Marix of Konrad" for formaive assessmen and analysis of academiccommuniy parnerships. The model has four dimensions (parnership, managemen, finance,

20 clinical Royeen communiy 11 and projec goals and oucomes) and was used in a federally funded, communiy-based raining program involving sudens in occupaional and physical herapy. Jensen and found hree assumpions emerged from use of he Inegraion Marix Model: (a) is cenral, (b) he dimensions ofhe model overlap, are inerdependen and significanly co-effec one anoher, (c) he operaion of dimensions is no linear, as posed by Konrad, bu nonlinear and fluid as consisen wih chaos heory (Jensen and Royeen, 200 I). Theoreical Assumpions " " experiences ype Mehodological Ii This research sudy was guided using he following assumpions: (a) Parnerships are an effecive means for communiy healh organizaions o build on communiy asses, develop communiy capial and enhance heir services; (b) Service-learning is an educaional mehod by which graduae nursing faculy can enhance he qualiy and diversiy of learning and provide sudens wih opporuniies for engaged ciizenship; (c) ACPs are a of parnership which may involve communiy healh organizaions and schools of healh professions educaion, specifically graduae programs in nursing; (d) ACPs should srive o exemplify bes pracices in service-learning and principles of successful parnerships. Underpinnings Qualiaive research is appropriae when lile known abou a opic and he grounded heory mehod of qualiaive research has uiliy when he researcher seeks o undersand a paricular process, in his case service-learning and academic-communiy healh parnerships (Huchinson, 1993). The discovery of grounded heory approach o qualiaive research was firs described by Glaser and Srauss in Subsequen, separae publicaions by Glaser and Srauss and ohers have furher developed and refined heir iniial work (Glaser, 1978; Glaser, 1992; Srauss and Corbin, 1997; Srauss and Corbin, 1998; Dey, 1999; and Charmaz, 2000).

21 12, Grounded heoriss search for, and seek o undersand and predic, social processes presen in human ineracion. There are wo ypes of grounded heories: formal and subsanive. Fonna! heories address a concepual level of inquiry while subsanive heories are generaed for a specific, circumscribed, and empirical area ofinquiry. Subsanive heories can be used o build formal heories (Glaser and Srauss, 1967). Grounded heory research is guided by he following assumpions: 1. "People do, in fac, order and make sense ofheir environmen, alhough heir world may appear disorded or nonsensical o observers. 2. Realiy is a social consruc. 3. Each group shares a specific social psychological problem ha is no necessarily ariculaed. 4. When a previously unariculaed problem and is resulan basic social psychological process are uncovered and concepualized, one can explain and predic behavioral variaion in a group" (Huchinson, 1993, pp ) Significance For Nursing Specific Relevance The findings ofhe sudy have specific relevance for professional nurses employed by he cas involved in he sudy as well as he graduae nurse educaors and graduae nursing sudens who parner wih hem. Facors influencing collaboraion ofcas wih he program Transferabiliy of graduae nursing educaion are discussed... persons ineresed in making he ransfer. The likelihood ofransferabiliy of he findings was In qualiaive research he exernal validiy ofhe findings canno be specified. Therefore, decisions concerning uiliy ofhe findings beyond he sudy seing are made by

22 l3 enhanced hrough use ofechniques such as he consan comparaive mehod of daa analysis and hick descripions (Glaser and Srauss, 1967 and Lincoln and Guba, 1993). The findings of his sudy have relevance for professional nurses pracicing in COs and for graduae nurse educaors in oher insiuions in four ways. Firs, professional nurses pracicing in COs will be informed ha ACPs are a sraegy o enhance social capial, build on communiy asses, compensae for limied resources and respond o naional calls for iner-agency collaboraion. Addiionally, ACPs allow nurses specializing in communiy/public healh (C/PHN) o implemen heir roles and funcions as described by he American Nurses Associaion (Council ofcommuniy Healh Nurses, 1985; Quad Council on Public Healh Nursing, 1999). For example: (a) one ofhe essenial public healh services is: "Mobilize communiy parnerships o idenify and solve healh problems" (Associaion of Sae and Terriorial Direcors ofnursing, 2000), (b) he second ene of public healh nursing saes: "The healh ofhe people is mos effecively promoed and proeced hrough collaboraion wih members of oher professions and organizaions" (Quad Council on Public Healh Nursing, 1999, p. 4) and (c) Sandard VIII of he Sandards of Communiy Healh Nursing Pracice (1985, p. 14) saes: " The nurse collaboraes wih oher healh care providers, professionals, and communiy represenaives in assessing, planning, implemening, and evaluaing programs for communiy healh". as engaged Second, he findings of his sudy aler faculy in graduae nursing educaion o ACPs a sraegy o: (a) implemen service-learning; (b) answer calls for increased suden learning in communiy-based, inerdisciplinary seings; (c) provide suden opporuniies for ciizenship; and (d) expose sudens ofall advanced pracice nursing specialies o populaion-focused healh promoion and disease prevenion and oher aspecs of public healh pracice. ACPs may also allow graduae nursing faculy o promoe he missions of

23 14 heir insiuion peraining o service and offer rich opporuniies for faculy pracice and scholarship. Third, he findings of his sudy may be used o educae praciioners in COs and graduae nursing educaion as o he principles of service-learning and ACPs and emphasize he imporance of assuring ha: communiy-idenified needs are being me, he relaionship is reciprocal, and parnership aciviies muually planned, implemened, and evaluaed. Finally, his sudy informs hose involved in ACPs of facors described by communiy parners as influencing such parnerships and suggess sraegies for assuring heir success. Summary In heir repor of he 1989 Wingspread Conference on Principles of Good Pracice for Combining Service and Learning (p.i), Honne and Poulson (1988) noed: "Service, combined wih learning, adds value o each and ransforms boh". ACPs can be a powerful means o achieve he goals of graduae nursing educaors and praciioners in COs. However, boh parners have a responsibiliy o assure he principles and bes pracices of servicelearning and ACPs are being me. There is dearh of published research concerning parnerships beween programs of graduae nursing educaion and COs, paricularly from he communiy perspecive. This sudy used he grounded heory mehod of qualiaive research o examine he experiences of communiy agencies wih he process of parnership wih a graduae nursing program.

24 15 Chaper II Review of he Lieraure Inroducion This research sudy examined he perspecives of communiy organizaions (COs) abou he process of parnership wih a graduae nursing program. Concepual underpinnings were derived from Cruz and Giles' (2000) model for examinaion of communiy perspecives of service-learning and Gelmon, Holland, Driscoll, Spring, and Kerrigan's (2001) model for assessmen of service-learning. Mehodological underpinnings of he sudy were based on Glaser and Srauss' Grounded Theory (1967). The purposes ofhis chaper are o: (a) discuss curren knowledge concerning academic-communiy parnerships (ACPs) in graduae nursing educaion and relaed opics, (b) idenify gaps in knowledge concerning CO's paricipaion in parnerships wih graduae nursing educaion, (c) discuss he secondary lieraure review, (d) describe he Grounded Theory mehod of qualiaive research, and (d) describe he auhor's experience wih ACPs. Process for Review oflieraure Peraining o ACPs According o Huchinson (1993), he grounded heory researcher accesses he lieraure wice during he sudy: (a) prior o daa collecion o discover sensiizing conceps I and gaps in knowledge (primary lieraure review) and (b) a he end of daa analysis o discover lieraure ha suppors, illuminaes, or exends he proposed heory (secondary lieraure review). The primary lieraure review included all informaion believed o have some bearing on he opic. Because very lile lieraure on collaboraion beween COs and graduae

25 16 programs of nursing was found, he review of lieraure began wih examinaion of inerorganizaional relaionships and proceeded hrough narrower opics more closely relaed o he opic of ineres. In keeping wih he approaches o daa collecion used in Grounded Theory research mehods (Glaser and Srauss, 1967), he professional lieraure was reviewed using a variey of sources: (a) Elecronic daa bases; (b) reference liss provided in books, aricles, and conferences aended by he researcher; (c) wo mea-analyses of service-learning research, one general and one specific o communiy agencies; (d) presenaions a conferences aended by he researcher and (e) professional organizaions including Communiy-Campus Parnerships for Healh and Campus Compac. Elecronic searches uilized MEDLINE, CINAHL and PSYCHinfo wih he key words: communiy-campus parnerships, collaboraion, parnerships, and service learning. The secondary lieraure review was underaken following compleion of daa analysis and examined heoreical and research lieraure idenified by he researcher afer he primary lieraure review. The process was essenially he same as ha described above. However, he focus was narrowed o lieraure relevan o he descripive heory which had emerged from he resuls. Raionale for Collaboraion for Communiy Healh The academic-communiy parnership (ACP) movemen in healh professions educaion began in he mid-1990's and coninued o gain momenum hrough he ime ofhis sudy. ACPs were he ougrowh of naional rends and forces affecing boh COs and programs of healh professions educaion. Parnerships beween programs of undergraduae nursing educaion and COs appeared early in he ACP movemen and are quie common oday, whereas parnerships involving graduae nursing educaion appeared laer and remain

26 17 less common. Lieraure concerning ACPs wih programs of graduae nursing educaion is sparse, largely anecdoal or descripive and focused on he academic perspecive. This examines he raionale for collaboraion beween COs and programs of graduae nursing educaion from boh perspecives. Communiy Organizaions For he purposes ofhis paper, a communiy organizaion (CO) is defined as an organizaion ha has an ineres in promoion of communiy healh and prevenion of disease. These effors may be primary (conribuing direcly o he organizaion's mission) or secondary (creaing condiions which faciliae achieving he organizaion's mission). Examples of COs include: volunary healh and human service organizaions, governmenal agencies (healh and human service, police, and fire/rescue), houses of faih, museums, and educaional insiuions such as pre-school and kindergaren (K) o grade 12. COs have long been encouraged o collaborae wih oher organizaions. Iner-agency collaboraion may allow agencies o coordinae, inegrae and/or enhance services, reduce duplicaion of effor; engage in communiy asse building, and achieve muual goals each organizaion could no accomplish alone (Bloxham, 1996; Krezmann and McKnigh, 1993; and Lasker, Weiss, and Miller, 2001). Today, as COs aemp o ameliorae or cope wih racial and ehnic dispariies in healh saus and increasingly limied financial and human resources, iner-agency collaboraion coninues o be seen as a desirable endeavor (Koplan and Fleming, 2000). The Unied Saes (US) Deparmen of Healh and Human Services' (DHHS) Healhy People 2010 (2000) idenifies communiy collaboraion as a core sraegy for achieving is' healh promoion and disease prevenion objecives, hose funding COs seek evidence of collaboraive effors in projec proposals, and some governmen-funded healh and human service programs are mandaed o collaborae (Bloxham, 1996).

27 18 Building Communiy - The Role ofcommuniy Organizaions Hancock (2001, p. 276) described four ypes of communiy capial, or forms of communiy wealh: 1. Human capial - healhy well educaed, skilled, innovaive and creaive people who are engaged in heir communiies and paricipae in governance. 2. Naural capial - high environmenal qualiy, healhy ecosysems, susainable resources and he conservaion of habia, wildlife, and biodiversiy. 3. Social capial - he "glue" ha holds communiies ogeher. I includes boh informal social neworks and more formal social developmen programs. 4. Economic capial - he (financial) means by which we can aain many of our human and social goals. Communiy building, also known as communiy developmen, refers o "communiy members working ogeher o achieve long-erm benefis for he communiy and an overall sronger sense of communiy" (Rohman, Anderson, and Schaffer, 1999). Communiy building, communiy healh and communiy capial are closely linked. The goals of communiy developmen include building he four ypes of communiy capial and achieving opimal healh for he communiy and is ciizens. Ye, human, social and economic capial canno be buil and communiy developmen canno occur wihou healhy ciizens. Iner-agency collaboraion is also a key sraegy in he asse or capaciy-building approach o communiy developmen. In many insances during pas years, communiy developmen was an aciviy underaken by professionals from ouside he communiy who idenified he communiy's problems and needs and ook acion o remediae hem. Communiy developmen was done "o" or "for" he communiy. Krezmann and McKnigh (1993) believe his approach can have numerous negaive effecs on he communiy,

28 relaionship principally "residens hink ofhemselves and heir neighbors as fundamenally deficien, vicims incapable of aking charge of heir lives and of heir communiy's fuure" (Krezmann 19 and McKnigh, 1993, p. 4). They advocaed a "communiy-as-parner" approach o communiy building ha empowers communiies and is "asse-based, inernally focused, and Asse-building sraegies include: (a) collaboraive effors among he communiy's groups and organizaions; (b) Door-o-door canvassing o idenify, in creaive ye simple and inexpensive ways, wha individual ciizens and families can and will conribue o heir driven" (Krezmann and McKnigh, 1993, p. 9). communiy; (c) developing a communiy asse map by diagramming he communiy's asses and poenial linkages and (d) board-ype games o educae paricipans in he process (Krezmann and McKnigh, 1993). Public healh is mos ofen hough of as a specific profession. However, all disciplines ha work o promoe communiy healh are, in some measure, pracicing public healh. Iner-disciplinary collaboraion and communiy-as-parner are key sraegies in he pracice of public healh. The cenral role ofcommuniy collaboraion in achieving he Healhy People 2010 objecives was noed previously. Public Healh in America (Public Healh Funcions Seering Commiee, 1995) saes he vision of public healh as "healhy people in healhy communiies" and pus forh en essenial public healh services including "Mobilize communiy parnerships o idenify and solve healh problems". These saemens reinforce he conceps of human capial and iner-agency collaboraion. Many COs employ communiy/public healh nurses or nurses such as school or parish nurses whose role includes populaion-focused healh promoion and disease and Sandards ofpublic Healh Nursing (PHN) Pracice (1999) emphasize he prevenion. Boh he Sandards ofcommuniy Healh Nursing Pracice (1985) and he Scope

29 20 inerdisciplinary, collaboraive naure of PHN pracice, he principle of communiy-asparner, and he prioriy given o healh promoion and disease prevenion. In 2000, he Associaion of Sae and Terriorial Direcors ofnursing (ASTON) wroe a "guide for he role ofhe public healh nurse as i relaes o populaion healh" (ASTON, 2000, p. 1). Even is ile, Public Healh Nursing: A Parnerfor Healhy Populaions, reflecs he collaboraive role of he PHN. Building Communiy-The Role ofgraduae Nursing Educaion Programs of graduae nursing educaion are clearly imporan asses in heir communiies and heir paricipaion in parnerships can conribue o communiy developmen effors. These aciviies also allow hem o respond o rends in healh professions educaion and healh care delivery, he goals of Healhy People 2010, and heir insiuions' missions peraining o communiy service. In heir Fourh Repor, Recreaing Healh Professional Pracicefor A New Cenury (1998), hree of five Pew Healh Professions Commission's recommendaions for all programs of healh professions educaion can be me hrough ACPs: "(a) require inerdisciplinary compeence in all healh professionals, (b) coninue o move educaion ino ambulaory pracice and (c) encourage public service of all healh professional sudens and graduaes" (Pew Healh Professions Commission, 1998, pp. iii-vi). Ofhe Commission's 21 compeences for he 21 SI cenury, a leas en can be addressed hrough ACPs and service rigorously pracice prevenive healh care, inegrae populaion-based care and services ino learning. Examples include: "embrace a personal ehic of social responsibiliy and service, o a diverse sociey, work in inerdisciplinary eams, and improve access o healh care for pracice, parner wih communiies in healh care decisions, provide culurally sensiive care hose wih unme healh needs" (Pew Healh Professions Commission, 1998, p. vii).

30 21 ACPs are also a sraegy by which graduae nursing programs can mee a leas wo advanced pracice nursing (APNs): "(a) Reorien APN educaion programs o prepare APNs of he four Pew Healh Professions Commission's recommendaions specifically argeed o payer source and (b) Emphasize he pracice syles ha are a criical par of APN including for he changing siuaions and seings in which hey are likely o pracice, regardless of he emphasis on prevenive and healh-promoing inervenions and aenion o psychosocial, environmenal, and resource facors (Pew Healh Professions Commission, 1998, p. viii). The American Associaion of Colleges ofnursing (ACCN), in heir repor: Nursing o Educaion's Agenda/or he 21"1 Cenury (1996), saed curricula should include inerdisciplinary eam paricipaion and sensiiviy o socioeconomic, religious, lifesyle and culural diversiy (AACN, 1999, p. 6). Guidelines recommended by he AACN included: (a) faculy pracice ha promoes links beween schools of nursing and heir communiies and (b) increased emphasis on suden learning in communiy-based seings. These recommendaions can be me, in par, hrough ACPs. ACPs also allow graduae programs in nursing o implemen service-learning, an educaional mehodology wih roos in experienialleaming. Numerous definiions of servicelearning exis; he one used for his sudy is from he Healh Professionals Schools in Service are A srucured learning experience ha combines communiy service wih explici learning objecives, preparaion, and reflecion. Sudens engaged in service-learning expeced o no only provide communiy service bu also o learn abou he conex in which he service is provided, he connecion beween he service and heir academic coursework, and heir roles as ciizens (Seifer, 1998, p. 274). he Naion (HPSISN) program:

31 22 Service-learning is implemened hrough parnerships wih communiy organizaions. Implemenaion of service-learning wih is associaed ACPs allows programs of graduae nursing educaion o respond o he aforemenioned challenges as well as well as o rends oward increased communiy-based care, diversiy and aging of he US sociey, and he dramaic decrease in engaged ciizenship (Punam, 1999). Graduae programs in nursing, as opposed o undergraduae nursing programs, can make unique conribuions o parnerships wih COs in ha heir sudens are licensed professional nurses, are skilled in he pracice of nursing, bring a variey of life experiences and can engage in service aciviies requiring a high level ofcriical hinking, auonomy and self-organizaion. Summary For over 200 years, mankind has recognized "A naion's healh is a naion's wealh" (Hancock, 2001, p. 275). Ye oday, ciizens ofhe Unied Saes, he wealhies counry of he world, coninue o experience dispariies of healh saus and access o healh care mos services. As recenly as 1997, Maya Angelou (1997, p. 108) observed: " If i is rue ha a chain is only as srong as is weakes link, isn' i also rue a sociey is only as healhy as is' deprived?" Eliminaing hese dispariies and assuring he underserved ofour communiies have opporuniies o achieve opimal healh can only be accomplished hrough he concered effors ofa communiy's ciizens, groups and organizaions. Parnerships beween programs of graduae nursing educaion and COs can conribue o hese effors and allow hem o: respond o rends and challenges in heir own disciplines and US sociey, carry ou heir missions, mee goals hey would be unable o achieve alone, and conribue o communiy capial by building on exising communiy asses.

32 23 Relaionships Collaboraion Beween Communiy Organizaions Dimensions ofiner-agency Relaionships among organizaions may vary widely in scope, consiuency, conex and degree of involvemen of each organizaion. They may range from a loosely srucured, shor-erm relaionship beween wo organizaions for he purpose of achieving a single, specific oucome o a highly organized, muli-agency parnership wih exernal funding and a separae leadership srucure ha may include individual ciizens and a number of relaionships: coordinaion, cooperaion, collaboraion, alliance, parnership, coaliion and communiy- based organizaions. The lieraure reveals many erms used o describe hese synergy. These erms may be used as nouns (ype of relaionship) or as verbs (process of The srengh of he relaionship may be viewed on a coninuum from cooperaion o relaionship), and numerous definiions exis for hese erms, some of which are synonyms. he coordinaion o collaboraion o parnership o synergy. Cooperaion is characerized by no formal rules and emphasis on he individual organizaion's goals and aciviies whereas coordinaion, collaboraion, and parnership involve an increasing degree of formaliy as o rules and srucure and muualiy of goals and aciviies (Rogers, Wheen and Associaes, 1982). Synergy, he highes level of engagemen, "enables a group of people and organizaions o combine heir complemenary knowledge, skills and resources so hey can accomplish more ogeher han hey can on heir own" (Cener for Advancemen of Collaboraive Sraegies in Healh, How Developed, 2002). Prior o daa collecion and analysis, he erm parnership was used o refer o he relaionships examined in his sudy. Parnership is he erm mos commonly used o refer o organizaional relaionships used o operaionalize service-learning (CCPH, 2000). Moffa, King, and Sowan (2002, p. 1) define parnership as: "wo or more eniies working

33 24 ogeher wih all paries sharing power, being acively involved, and having a vesed ineres in he success of he projec". The researcher has added he addiional elemen of "having muual goals". Coordinaion, cooperaion and collaboraion are seen as less srucured relaionships in which goals may be parallel raher han shared and will be discussed in furher deail in following paragraphs. Three models ofcollaboraion for communiy healh will be discussed and analyzed according o heir relevance o he curren sudy and research findings will be discussed. Prolivka's Frameworkfor Iner-agency Collaboraion described Prolivka's Concepual Framework for Ineragency Collaboraion was iniially in 1996 and is based on he works of several auhors in organizaional behavior. The framework describes ineragency collaboraion as a funcion of environmenal condiions, pre-exising organizaional siuaion facors, and ask characerisics. Once alliances are formed, ransacional facors (inensiy, formaion, decision-making mehods, size, and srucure) influence he oucomes (organizaional, iner-organizaional, clien, and Hemlich, collaborae have communiy). Prolivka, a public healh nurse researcher, and colleagues have esed he framework and assessed he degree ofcollaboraion for hree groups oforganizaions: rural sex educaion programs (Prolivka, 1996), public healh and communiy menal healh agencies (Prolivka, Kennedy, and Chaudry, 1997) and rural early inervenion collaboraives (Prolivka, Dresbach, and Ellio, 2001). The organizaions sudied were chosen because hey should o provide opimal clien services or are mandaed o collaborae. The auhors no sudied organizaions ha purposefully eleced o parner o achieve a common goal. Daa collecion mehods included semi-srucured inerviews and a survey insrumen

34 In 25 designed o assess he five domains of he model. The insrumen was modified for each sudy based on available and relevan indicaors for each componen of he model. sudies, pah analysis indicaed ha knowledge of saff, goals and services ofoher agencies was Iinked wih ineragency processes and wih ineragency relaionships (1997) or oucomes (2001) (Prolivka, e ai., 1997 and Prolivka, e ai., 2001). Therefore, communicaion among organizaions as o roles, goals, and services is a key facor in iniiaion and oucomes of each siuaion, he level ofcollaboraion was low. In boh he 1997 and 2001 ineragency collaboraion. A Frameworkfor he Developmen ofcommuniy Healh Agency Parnerships In 1997, Sco and Thurson published heir "Framework for he Developmen of Communiy Healh Agency Parnerships". The auhors are from Canada, where, due o he naional healh care sysem, iner-agency collaboraion is srongly encouraged. Sco and Thurson were concerned wih large scale parnerships characerized by esablishmen ofa referen organizaion. Their aricle was chosen for inclusion in his proposal because i was he only sudy found during he lieraure review ha used grounded heory mehods. The purpose ofhe sudy was o "generae subsanive heory regarding he developmen of effecive parnerships among communiy agencies working wih vulnerable populaions" (Sco and Thurson, 1997, p. 416). Sco and Thurson (1997) inerviewed eigh individuals who were currenly involved in iner-organizaional parnerships. The heoreical framework ha emerged during daa analysis includes six caegories and heir associaed properies: (a) Exernal facors adminisraive and service provision, (b) domain - recogniion and suppor, (c) parnership characerisics - groundwork, organizaional srucure, resources, represenaion, and repuaion, (d) parner characerisics - organizaional srucure, resources, represenaion and

35 26 repuaion, (d) communicaion - ype and area, and (e) operaions - ype and area (Sco and Thurson, 1997, p. 418). Sco and Thurson inegraed he six caegories ino a process model for parnership developmen. Key componens of an effecive parnership process include: (a) shared vision wih muual commimen of all parners; (b) gaining commimen from poenial parner agencies; (c) agreemen on parnership characerisics, communicaion sraegies, and operaions; (d) implemenaion; and (e) evaluaion (Sco and Thurson, 1997). Framework/or Parnership Synergy In 2001, Lasker, e al. ofhe Cener for Advancemen ofcollaboraive Sraegies in Healh (CACSH) ofhe New York Academy ofmedicine proposed a framework for effecive parnership funcioning and esed i in a Naional Sudy of Parnership Funcioning ha included 63 parnerships and 815 parnership paricipans. Eligible parnerships were preexising (a leas wo years), broad-based, and had a leas en parners (Cener for he Advancemen ofcollaboraive Sraegies in Healh, NSPF and How Developed, 2002). A cenral hypohesis ofhe sudy was ha parnership synergy is key o he ransiion from parnership funcioning o parnership effeciveness. The sudy indicaed he majoriy of he 63 parnerships had been relaively successful in achieving parnership synergy. Four dimensions of parnership synergy were idenified: (a) leadership effeciveness, (b) parnership efficiency, (c) adminisraion and managemen effeciveness, and (d) he sufficiency of non-financial resources. Leadership effeciveness was he mos powerful deerminan (Weiss, Miller and Lasker, 2001). A key oucome ofhe sudy was developmen of an on-line, ineracive Parnership Self-Assessmen Tool. To use he ool, parnerships need o have been in exisence for a leas six monhs, have a leas five acive parners, and mee oher process crieria (CACSH, Parnership Tool, 2002).

36 Bloxham's Case Sudy ofiner-agency Collaboraion 27 Bloxham (1996) conduced in-deph inerviews wih 25 saff from four parner agencies working ogeher in a series of adolescen sexual healh iniiaives. Sudy findings were congruen wih her lieraure review and showed effecive coliaboraion was influenced by "shared aims, muual respec, and good working relaionships" (Bloxham, 1996, p. 389). parnership may no faciliae long erm success and ha sraegic planning by key leadership Bloxham (1996) also suggesed ha an informal, neworking approach o developmen of a Research number persons is also necessary. Summary and Conclusions and heory developmen concerning iner-agency collaboraion for communiy healh is designed o examine he perspecives ofall parners and has revealed a of facors influencing such relaionships. Three concepual frameworks, and heir associaed research, and one research sudy were summarized. Alhough here are some differences among he facors found o influence success of iner-agency collaboraion, here are also many similariies: a common goal, plan and srucure agreed upon by all parners; a reciprocal relaionship wih rus and respec; coninuous, effecive communicaion; and program evaluaion. These facors are congruen wih he principles of parnerships. Noable Principles excepions among he findings include: Lasker e a. (2001) emphasis on leadership more srongly han he oher auhors, and Prolivka's (1996) separae se offacors concerning ask characerisics. ofacademic-communiy Parnerships (ACPs) A number of organizaions have published principles or sandards for servicelearning and/or academic-communiy parnerships. Four will be discussed here as hey reflec he evoluion from an emphasis on learning o an emphasis on parnerships and each is

37 I 28 I I I I I I I I I I referred o in publicaions reviewed on ACPs in higher educaion, healh professions educaion and nursing educaion. Earlies effors o describe effecive service-learning programs recognized he essenial and inegral role of he communiy and reciprociy beween parners. Reciprociy is defined as "muual dependence, acion or influence" (Merriam-Webser, 1994). In 1979, Rober Sigmon suggesed hree principles of service-learning: (a) "Those being served conrol he service(s) provided, (b) hose being served become beer able o serve and be served by heir own acions, and (c) hose who serve also are learners and have significan conrol over wha is expeced o be learned" (Sigmon, p. 10). In 1998, leaders in he service-learning movemen me o ariculae more deailed and explici principles and develop a research agenda for service-learning. The Principles of Good Pracice for Combining Service and Learning (Honne and Poulsen, 1989) (see Appendix A) I I inroduced he concep of reciprociy as well as acive involvemen of all sakeholders and hose served define heir own needs. The principles included jus wo references o "learning" and referred o he link beween educaion and communiy as "programs". In heir narraive I I I I I I I I I I explanaion of he principles, he auhors acknowledged he essenial link beween servicelearning and academic-communiy parnerships. However, hey wen on o noe ha despie he emphasis on learning, he Principles were no limied o parnerships involving schools bu relae o programs and policies based in any communiy organizaion (Honne and Poulsen, 1989). Noe he inroducion of he erm "parnership" o refer o he relaionship beween he educaional insiuion and he communiy agency. Communiy Campus Parnerships for Healh (CCPH), a naional, non-profi organizaion founded in 1996, has been a leader in he academic-communiy parnership movemen. Their mission is o "foser parnerships beween communiies and healh I

38 ~ 29 professions schools" (Seifer, 1998, p. 276) and is refleced in nine principles of parnerships (Seifer and Maurana, 2000, p.7) (see Appendix B). Alhough CCPH suppors service-learning direc (Seifer, 1998), he CCPH principles, unlike he Wingspread documen, make no reference o learning, refer o he linkages beween educaion and communiy as "parnerships"; make no reference o service; and place even sronger emphasis on he imporance ofreciprociy beween parners; muual goals, plans and oucomes; and susained relaionships. Excep where he Sigmon (1979) and Wingspread principles are specifically referenced in aricles reviewed for his paper, he CCPH principles will be he poin of reference for bes pracices in ACPs. I is he more recen documen and is direced oward parnerships beween schools ofheaih professions educaion and communiy healh organizaions. communiy Summary As hey have evolved, principles of service-learning and/or ACPs have become increasingly congruen wih he enes of communiy developmen and communiy capaciy building as well as conceps of iner-agency organizaions. Wheher academic-communiy parnerships are guided by he Sigmon, Wingspread, or CCPH Principles, he criical roles of reciprociy, muual rus and respec, and acive involvemen ofall sakeholders are fundamenal. The following review of he lieraure on ACPs and service-learning demonsraes ha publicaions in his area focus largely on he academic perspecive and end o be anecdoal and descripive. There is a need for rigorous, scholarly examinaion of he perspecive of paricipaion in parnerships wih insiuions of higher educaion, and graduae nursing educaion in paricular.

39 f 30 a\ Communiy Perspecive ofacademic-communiy Parnerships in Higher Educaion Theoreical Lieraure As he service-learning movemen in higher educaion experienced rapid growh during he 1990's so did research in service-learning. In 1991, 1997, and 2000 leaders in he field assessed he curren sae of service-learning research and proposed an agenda for he coming years. The communiy perspecive has been a consisen heme in calls for servicelearning research. However, suden oucomes have been he primary focus of sudy. The evaluaion model developed a Porland Sae Universiy (PSU) and firs repored in PSU model uses a muli-consiuency approach ha includes communiy. I has been furher developed and refined and was used in evaluaion ofhe firs naional demonsraion program of service-learning in a se of disciplines, The Healh Professions Schools in Service An early excepion o he focus on suden oucomes was he comprehensive o he Naion (HPSISN) program. HPSISN involved 17 schools of healh profession Two oucomes ofhe evoluion of he PSU model have been he formaion of he naional organizaion, Communiy Campus Parnerships for Healh, and an assessmen handbook. Alhough he ile indicaes he handbook is for assessmen of service-learning and civic engagemen, he auhors noe i has uiliy for assessmen ofa "broad array of educaion. parnership aciviies including bu also ranscending service-learning" (Gelmon e ai., 2001, p.10). The assessmen approach uses a muli-consiuency marix framework derived from he projec goals. The auhors cauion ha in assessing he impac on he communiy, care mus be aken o explore how he "paricipaion of he parner organizaion in he academic aciviy affecs he parner" and avoid wha migh be viewed as a performance review of he organizaion (Gelmon e ai., 2001, p.87). Recommended focus areas for assessing communiy

40 31 I parners include: (a) "capaciy o fulfill organizaional mission (economic and social benefis), (b) naure of he communiy-universiy relaionship (parnership), (c) naure of he of he parnership" (Gelmon e ai., 2001, pp ). Alhough he purpose of he framework communiy-universiy ineracion, (d) saisfacion wih he parnership, and (e) susainabiliy communiy ino service-learning I insiuions reviewed evaluaion is o assess oucomes, feedback concerning process is sough as well. Mehods for assessing parners include surveys, observaion, focus groups, and inerviews. Deailed insrucions and insrumens are provided. Componens of he handbook were incorporaed he design of his sudy. In 1999, Eyler, Giles and Gray published a mea-analysis of research on he impac of on sudens, faculy, insiuions, and communiies from Of he 68 oal sudies, jus nine addressed he impac of service-learning on communiies. Overall findings included: (a) saisfacion wih suden paricipaion, (b) service-learning provides useful service in communiies and (c) communiies repor enhanced universiy relaions. Samples in he nine sudies ranged from four sudens o over 6000 paricipans (sudens, and communiies combined). In mos of he repors, he primary sample was sudens wih a brief reference o feedback from communiy parners. None ofhe repors focused solely on he communiy (Eyler e ai., 1999). In he Fall, 2000 Special Issue of he Michigan Journal ofcommuniy Service Learning: Sraegic Direcions for Service-Learning Research, Cruz and Giles (2000) curren service-learning lieraure relaed o communiy. They found ha mos service-learning lieraure concerning communiy is anecdoal and descripive or program in which communiy is one variable among ohers. Very few aricles repored rigorous research focused only on communiy. Cruz and Giles suggesed reasons for he dearh of service-learning research on communiy and curren knowledge abou he value of

41 32 learning service-learning o communiies. The key findings and key claims of welve repors on service-learning and communiy were caegorized ino hree broad opic areas: (a) conribues o communiy developmen, (b) bridges own-gown gaps, and 3) offers benefis o communiy parners (Cruz and Giles, 2000). Two of he opic areas were very similar o hose noed in he 1999 repor by Eyler e al. Cruz and Giles (2000) suggesed a new model of service-learning research on communiy which would: (a) Have he parnership iself as he uni of sudy, (b) be consisen wih good pracices of service-learning, (c) use acion research and Cd) focus on asses. The conceps of communiy asse building and parnership as well as he principles of serviceand parnership were discussed in deail earlier and were inegraed ino he design of his sudy. Acion research, wih is' prioriies on communiy voice and involvemen, clearly has relevance for service-learning research design. However, i is no appropriae o he purpose of his sudy as he overall MSN program projec had been fully implemened a he ime of his sudy. Cruz and Giles cied Gelmon e al.'s (2001) guide for assessmen of service-learning and civic engagemen as an example of one ofwo exising models ha synhesize he four conceps in heir "new approach" o service-learning research focused on communiy. Research Lieraure The primary review ofhe lieraure elicied five repors of research involving communiy parners only, or muliple sakeholders including communiy parners, from (Johnson, Young and Johnson, 1997; Geschwind, Ondaaje, and Gray, 1997; Gelmon, Holland, and Shinnamon, 1998; Vernon and Ward, 1999 and Ferrari and Worrall, 2000). The insiuions of higher educaion included communiy colleges, four-year colleges and research universiies in urban and rural seings. Communiy parners also varied as o

42 locaion, size, mission and services provided. The number of communiy paricipans ranged from 30 (Ferrari and Worrall, 2000) o 443 (Geschwind e ai., 1997). Daa collecion mehods 33 included surveys and/or inerviews and rigor ofhe repors varied from limied (Johnson e ai., 1997 and Geschwind e ai., 1997) o deailed discussion of mehods (Gelmon e ai., 1998; Vernon and Ward, 1999 and Ferrari and Worrall, 2000). Four repors focused on he parner and parnership (Johnson e ai., 1997; Geschwind e ai., 1997; Gelmon e ai., 1998; and Vernon and Ward, 1999). Ferrari and Worrall (2000) focused only on he parners' evaluaion of he sudens. Overall, all sudies repored overwhelmingly posiive feedback from he communiy agencies. Parners repored benefis o sudens (Johnson, Young and Johnson, 1997 and Vernon and Ward, 1999), agencies (Johnson e ai., 1997; Geschwind e ai., 1997; Gelmon e ai., 1998; and Vernon and Ward, 1999) and communiies (Johnson e ai., 1997). Agency benefis cenered around improved abiliy o mee agency goals (Johnson e ai., 1997; Geschwind e ai., 1997; Vernon and Ward, 1999). Ferrari and Worrall (2000) found communiy parners benefied from sudens' work skills and service skills. Four sudies found improved communiy-campus relaions and/or improved communiy parner percepions of he universiy (Johnson e ai., 1997; Geschwind e ai., 1997; Gelmon e ai., 1998; Vernon and Ward, 1999). Three sudies repored lile or no impac on supervisors (Johnson e ai., 1997; Geschwind e ai., 1997; Gelmon e ai., 1998). Saisfacion wih he parnerships was very high. Over 90% of paricipans in four sudies indicaed hey would recommend academic-communiy parnership and/or involves sudens again (Johnson e ai., 1997; Geschwind e ai., 1997; Gelmon e ai., 1998). Gelmon e al.( 1998) also found parnerships promoed neworking among communiy agencies.

43 34 The key recommendaion across all four parner-focused sudies was he need for improved collaboraion beween he educaional insiuion and communiy parners. Areas of difficuly included: scheduling, aendance, logisics such as ransporaion, and suden preparaion/raining. For example, Gelmon e ai. (1998, p. 54) noed "parners... found insiuions operaed in bureaucraic ways ha did no foser inerdisciplinary cooperaion seen as essenial o addressing communiy needs." This recommendaion perained o boh cenral offices for suden service (when insiuions had hem) and individual course faculy. Several sudies noed agencies believed educaional insiuions should ake a more acive Geschwind e ai., 1997; Gelmon e ai., 1998; Vernon and Ward, 1999). role in coordinaion and communicaion wih heir communiy parners (Johnson e ai., 1997; sough Vernon and Ward (1999) and Gelmon e ai., (1998) repored communiy parners recogniion for heir role as eachers, opporuniies o visi campus, a voice in he parnerships, and a sense of paricipaion from planning o evaluaion. All five sudies noed he imporance of including communiy organizaions in formal evaluaion (versus anecdoal commens) of he parnerships. Despie widely publicized principles of service-learning and academic-communiy parnerships ha emphasize reciprociy, research sudies abou communiy organizaions' perspecives of parnership are few. Findings of he few repors on communiy percepion's of ACPs indicae posiive oucomes and a srong desire o coninue, and expand, he relaionship. Coordinaion and communicaion wih he educaional parners are key facors in success of he relaionship.

44 35 Academic-Communiy Parnerships in Healh Professions Educaion Concepual Framework Review of he lieraure revealed one concepual framework for academic-communiy parnerships in healh professions educaion. Jensen and Royeen (2000) led an academiccommuniy parnership, funded by he US Healh Resources and Services Adminisraion. Sudens in physical and occupaional herapy provided rehabiliaion services o members of.' coordinaion Inegraion analysis. analysis of projec operaions. The Inegraion Marix, originally described by Konrad in 1996,"addresses 12 dimensions ofservice developmen and delivery, represening core elemens involved when... organizaions work ogeher on a projec" (Jensen and Royeen, 2000, p. 169). Konrad also suggesed ha he degree of sharing among organizaions can vary and described five levels of inegraion: informaion sharing and communicaion, cooperaion and coordinaion, collaboraion, consolidaion and inegraion (Jensen and Royeen, 2000). This parallels he coninuum of srengh of iner-organizaional relaionships (cooperaion o o collaboraion o synergy) discussed earlier in his chaper. Jensen and Royeen (2000) lis he quesions used o assess he 12 dimensions of he Framework. However, hey do no discuss heir mehods ofdaa collecion and Three assumpions emerged from he projec ha suggesed a need for modificaion of he Inegraion Marix: (a) "communiy is cenral, (b) inerdependence and co-effec, and he Winnebago and Omaha Indian Naions in Nebraska. The Inegraion Marix of Konrad, a concepual framework developed for he projec, was used o shape formaive assessmen and (c) mulidimensional and non-linear" (Jensen and Royeen, 2000, p.174). The model was revised and depiced as a pyramid wih communiy as foundaion and communicaion (culurally -sensiive, formal and informal) as pervasive. Above he base, are four key elemens of parnerships: parners, managemen aciviies, finance and projec goals and

45 36 oucomes. The key imporance of communicaion parallels he findings of he sudies discussed in he previous secion ofhis paper (communiy parners' percepions of ACPs in higher educaion). Research Lieraure The primary review of he lieraure revealed one case sudy and one research sudy ha repored communiy agencies' percepions of parnership wih a non-nursing program of healh professions educaion. In he CCPH Guide for Developing Communiy Responsive Models in Healh Professions Educaion, Baker (1997) described his agency's en- year experience in parnership wih he Universiy of Connecicu School of Medicine. This was he only aricle found in which a communiy agency described heir perspecive of parnership wih an insiuion of higher educaion. Baker described he parnership as posiively impacing boh parners: (a) Improved agency abiliy o mee clien healh needs, (b) cos-effecive for he agency, (c) posiive changes in he medical school curriculum, (d) suden expansion o include nursing, and (e) a communiy service requiremen for all medical sudens. Baker concludes wih facors ha are key o success of an ACHP: (a) a sense of ownership by all involved, (b) good communicaion, (c) opporuniies for expecaions, from communiy parner involvemen on campus, (d) a wrien agreemen of roles and (e) shared vision, and (f) recogniion (Baker, 1997). These facors reierae findings repored in he principles of parnership and he previous secion on academiccommuniy parnerships. In 2001, Wolff and Maurana repored findings ofheir qualiaive sudy ofeigh communiy-academic parnerships a five academic healh ceners. Tweny-five paricipans he eigh communiy parners were inerviewed. Wolff and Maurana (2001) provide a deailed descripion of research mehods used in he sudy; however, a full page of correcions

46 37 appeared in a laer issue ofhe journal. Nine major hemes emerged as facors paricipans hough srongly influenced he effeciveness of ACPs: (a) creaion and nururing of rus; (b) respec for a communiy's knowledge; (c) communiy-defined and prioriized needs and goals; (d) muual division of roles and responsibiliies; (e) coninuous flexibiliy, compromise, and feedback; (f) srenghening ofcommuniy capaciy; (g) join and equiable allocaion of resources; (h) susainabiliy and communiy ownership; and (i) insufficien funding periods. Alhough hese hree repors ake very differen forms, hey coninue o reflec hemes idenified by previous auhors: reciprociy, muualiy of goals and plans, clear and coninuous communicaion among all sakeholders, and a susained relaionship. Boex and Henry (200 I) summarize he concep of academic-communiy parnerships succincly in heir "Commenary" o Wolff and Maurana's repor. They posed he quesion: "Why does anyone ener ino a parnership?" and responded wih: "o accomplish a goal ha canno be accomplished alone" and defined parnership as "an open collaboraion of shared risk and reward" (Boex and Henry, 2001, p. 151). Academic-Communiy Healh Parnerships Wih Undergraduae Nursing Programs Of he various disciplines in healh professions educaion, undergraduae nursing educaion was early o embrace service-learning and many faculy have wrien of heir experiences. Mos of he lieraure is anecdoal and descripive in naure wih he focus clearly on he academic perspecive. Of 25 aricles and one book, none focused specifically on communiy parners andjus six repored findings of research sudies (Hales, 1997; Simoni and McKinney, 1998; Schneiderman, Jordan-Marsh, and Baes-Jensen, 1998; Whie, Fesa, Allocca, and Abraham, 1999; Peerson and Schaeffer, 1999; and Schaffer, Maher, and Gusafson; 2000).

47 38 Research varied eiher Lieraure Of he aricles reporing findings of research, he number of suden paricipans from 7 o 48. All six aricles repored using service-learning and hree referred o he Sigmon, Wingspread or HPSISN principles. Simoni and McKinney (1998) referred o Sigmon's principles of service-learning; Peerson and Schaeffer (1999) cied porions of he Wingspread Principles and Schaffer, e al. (2000) referred o HPSISN's key characerisics of service-learning experiences. Three sudies (Schaffer, e ai., 2000; Hales, 1997; and Whie e ai., 1999) were framed wih concepual frameworks. Schaffer e al. (2000) framed he sudens' aciviies (healh needs assessmen) and Whie e al. (1999) used Boyer's model of scholarship. Hales (1996) cied six feaures ofservice-learning as described by he Kellogg Faculy Commiee on Service-Learning of he Universiy of Michigan as service-learning heory. However, hese feaures are oriened o suden learning and no menion of reciprociy or communiy involvemen in he process is made. The level of rigor and exen o which feedback from communiy agencies was sough varied. Simoni and McKinney (1998) and Hales (1997) focused oally on suden quoed feedback from he agency direcor bu did no sae he mehods by which he daa was oucomes wih no menion of feedback from communiy agencies; Schaffer e al. (2000) colleced. Whie e al. (1999) and Schneiderman e al. (1998) indicaed ools were developed o seek agency (Whie) or agency and clien (Schneiderman) feedback and repored he findings. However, Whie e al. (1999) and Peerson and Schaeffer (1999) did no discuss how he insrumen was developed and Schneiderman e al. (1998) menioned only ha he ool was assessed for conen validiy. Four aricles referred o parnership in he lieraure review while Whie e al. (1999) and Schaeffer e al. (2000) referred o parnership in reporing and discussing findings ofheir sudies.

48 39 Of he four research sudies ha sough feedback from he communiy agencies, findings were highly posiive as o agency evaluaion of suden performance and conribuions o agency goals and services. Addiionally, Schneiderman e al. (1998) found 95% of cliens saw suden services as beneficial and fel sudens learned during he experiences. Agencies sough o coninue he relaionships and have more sudens. Peerson and Schaffer (1999, p. 213) repored several problems idenified by agencies: "unclear communicaion, errors in daa enry and lack of suden follow-hrough wih assigned schedules". Recommendaions included: agencies reques increased role in orienaion and scheduling of sudens (Whie e ai., 1999); sudens learn how o inerac wih diverse culural groups (Schneiderman e ai., 1999); more direc communicaion wih faculy (Peerson and Schaffer, 1999). Descripive nursing lieraure Nineeen aricles and one book were found ha described anecdoal repors of experiences wih service-learning or academic-communiy healh parnerships involving undergraduae nursing educaion. Types of academic courses and communiy seings varied widely as did he number of sudens and agencies. The academic perspecive predominaed. Four of he 21 repors were co-auhored by boh he academic and communiy organizaions and gave a more balanced repor of boh perspecives. (Corbe, Seer and Rappuchi, 2000; Sebasian, Davis, and Chappell, 1998; Ellenbecker, Byrne, O'Brien and Rogosa; 2002 and Ellenbecker, O'Brien and Byrne, 2002). Ellenbecker e al. (2002) published wo aricles on heir projec, one from he academic perspecive and one from he communiy perspecive. The second aricle gave a deailed saisical repor ofservices provided and clien oucomes bu did no discuss he parnership process, problems or recommendaions for improvemen.

49 Garbe, or 40 Twelve aricles indicaed paricipaion in parnerships (Corbe e ai., 2000; Sebasian e ai., 1998; Riner and Becklenberg, 2001; Sernas e ai., 1999; Whie and Henry, 1999; Bailey e ai., 1999; Sacke, Hendricks and Pope, 2000; Rodgers, 2001; Hammer, Wilder, Avery, and Byrd, 2002; Ciaccio and Walker, Ellenbecker e. ai., 2002 and Ellenbecker e ai., 2002). Thireen of he aricles indicaed use of service-learning (Calliser and Hobbins 2000; Miller and Swanson, 2002; Kulewicz, 200 I; Riner and Becklenberg, 200 I; Sernas e al., 1999; Whie and Henry, 1999; Rodgers, 2001; Drevdahl, Shannon, Grevsad, 200 I; Mayne and Glascoff, 2002; Hammer e al, 2002; Ciaccio and Walker; Bile e ai., 2002 and Bailey e ai., 1999). Three repors referred o he Sigmon, Wingspread, HPSISN (pre-ccph) or CCPH principles of parnership (Whie and Henry; 1999; Whie, 1999; Sebasian e ai., 1998; and Rodgers, 200 I). Bile e al (2002) referred o four essenial elemens of service learning including reciprociy and meaningful service. One aricle (Long, 2002) discussed advanages of home healh agency collaboraion wih nursing educaion raher han reporing a specific experience. Eigh of he 16 remaining aricleslbook repored feedback from communiy agencies (Corbe e ai., 2000; Sebasian e ai., 1998; Kulewicz, 2001; Sernas, O'Hare, Lehman and Milligan, 1999; Whie and Henry, 1999; Hammer, Wilder, Avery and Byrd; 2002; Bile, Duggleby and Ellison, 2002; and Bailey, Carpener, and Harringon; 1999). In mos cases ha feedback was noed in one or wo senences and he mehods ofobaining he feedback were no explained. All communiy feedback, wheher from agency saff or cliens, was repored as highly posiive. No problems recommendaions were discussed. Excepions were he Bailey e al (1999) book and he Corbe e al. (2000) aricle. Bailey and colleagues (1999) repored heir experiences as par of he HPSISN projec and proposed a guide for service-learning. One chaper was devoed o "Communiy Parnerships

50 in Service-Learning". The chaper included "sories" wrien by communiy agencies ofheir 41 experiences wih he parnerships. The sories included oucomes as well as recommendaions focus groups held wih he communiy agencies. They were o: (a) mee he needs ofhe agency; (b) prepare sudens for he experience; (c) ensure ha sudens are reliable, dependable, and undersand expecaions ofhem; (d) srenghen parnerships wih more feedback and beer communicaion; (e) include communiy in reflecion aciviies; and (f) coninue he focus groups. Alhough Bailey e al. (1999) provided heir qualiaive and quaniaive insrumens for evaluaion of suden oucomes, hey did no provide he inerview guide used for he focus groups. Corbe e al. (2000) repored heir experiences wih undergraduae nursing-home healh agency parnerships. Benefis o agencies included: research, service and economic oucomes. Facors in successful parnerships included: "(a) adminisraive advocacy and suppor from boh parners, (b) muual respec, (c) eam work, (d) recogniion ofhe srenghs and conribuions ofall parners, (e) boh organizaions should engage in educaion or service projecs firs o allow ime o esablish muual rus and respec; (e) build on he srenghs of boh insiuions, (f) coninue o acknowledge conribuions ofeach pary, and (g) iniiae collaboraive research afer he parnership has become esablished" (Corbe e ai., 2000, p. 14). Rodgers (2001) noed ha, in order o esablish a parnership beween an academic uni and a communiy, he fi beween he communiy's needs and he universiy and academic uni's mission and goals mus be explored and role expecaions offaculy mus be clarified. She also noed ha he academic uni mus make a commimen o he communiy, for improvemen. The chaper also repored sraegies for susaining parnerships arising from paricularly in respec o wheher he experience will be one ime, episodic, or coninuous;

51 42 wheher he same faculy member will always run he projec; wheher inerrupion of service during college breaks will diminish he service and wheher he aciviy can run uninerruped Summary ofundergraduae Nursing Findings of review of undergraduae nursing experiences in service-learning and if necessary o mee he communiy's needs. wih discussing linking wih communiy agencies parallel hose of higher educaion and healh professions educaion. Alhough, nursing lieraure is replee wih repors of undergraduae nursing experiences wih service-learning and linkages wih communiy agencies, mos are anecdoal and, for hose repored as research, he level of rigor varies widely. Moreover, despie he fac ha a leas 16 of he repors referred o engaging in parnerships and/or service-learning, he focus was clearly on he academic perspecive. Effors were made o mee communiyidenified needs. Minimal aenion was given o describing how reciprociy was assured or feedback from communiy agencies regarding heir percepions of he relaionship. The excepions, Bailey e ai. (1999) and Corbe e ai. (2000) in paricular, were congruen previously discussed facors in assuring successful parnerships: reciprociy, muual rus and respec, clear and coninuous communicaion, and building on he srenghs of boh parners. Academic-Communiy Parnerships Wih Graduae Nursing Programs service-learning. graduae A comprehensive review ofhe lieraure revealed six repors of ACPs wih a program in nursing (Logsdon and Ford, 1998; Horak, O'Leary and Carlson, 1998; Scheideberg, 1999; Luz, Herrick and Lehman, 2001; Cohen and Milone-Nuzzo, 2001; Narsavage, Lindell and Bachelor, 2001); Narsavage, Lindell, Chen, Savrin, and Duffy, 2002). Five aricles were anecdoal repors of shor-erm, one course experiences wih Narsavage e ai., (2001 and 2002) repored research findings of an MSN

52 43 program's experience wih service-learning. The Horak, O'Leary, and Carlson (1998) aricle did no include a nurse auhor alhough nurse praciioner sudens were included in he mulihealh professions projec. Like he undergraduae nursing lieraure, he six graduae nursing repors clearly focused on he academic perspecive. None included a concepual framework for he parnership, none focused solely on he percepions ofhe communiy parner, and none of he auhors represened he parner agency. Alhough five of he repors indicaed hey were framed in service-learning (Logsdon and Ford, 1998; Scheideberg, 1999; Luz, Herrick, and Lehman, 2001; Cohen and Milone-Nuzzo, 2001; Narsavage e ai., 2002), only hree (Horak, O'Leary, and Carlson, 1998; Luz, J., Herrick, C. and Lehman, B., 2001; and Narsavage e ai., 2002) referred o he relaionship wih communiy agency as a parnership. The ohers referred o he agencies as "sies" (Lodgson and Ford, 1998), "agencies" (Cohen and Milone- Nuzzo, 2001) or "communiy" (Scheideberg, D., 1999). Three aricles repored feedback from communiy agencies (Horak e. ai., 1998; Cohen and Milone-Nuzzo, 2001; and Narsavage e. ai., 2002). However, only Horak e. al. (1998) indicaed how he informaion was obained and ha was hrough inerviews. Feedback from communiy agencies was uniformly posiive and included: (a) requess for addiional sudens or o coninue he relaionship (Cohen and Milone-Nuzzo, 2001; Horak e. ai, 1998), (b) valuable conribuions o agency goals (Cohen and Milone-Nuzzo, 2001; Narsavage e ai., 2002), (c) greaer benefis o agency from graduae nursing sudens compared o sudens of oher disciplines (Cohen and Milone-Nuzzo, 2001); (d) cliens pleased wih direc services (Narsavage e. ai., 2002); (e) conribuions o healhcare in he communiy (Narsavage, e. ai., in press); (f) cliens benefied from suden projecs (Horak e ai, 1998); welcomed muli-disciplinary, suden eam approach (Horak e. ai, 1998). Luz e.

53 al, 44 communiy ogeher (2001) made no reference o agency feedback bu noed a quoe from one communiy clien who found he suden services o be helpful. None ofhe six repors included recommendaions from he communiy agencies as o how o improve he relaionship. Horak e al.( 1998) noed one agency had no suggesions for improvemen and alhough he aricle concluded wih guidelines for working wih communiy agencies, he sraegies perained largely o he academic parner. In summary, analysis of informaion provided in he six published repors of servicelearning a he graduae level of nursing educaion working wih communiy agencies indicaes: (a) he focus was clearly on he academic perspecive, (b) eiher here was no parnership or he level of parnership could no be deermined, and (c) feedback from agencies, if sough a all, was usually informal. Summary and Conclusions: Pre-Sudy Review ofhe Lieraure and Gaps in Knowledge This secion of Chaper II has defined parnerships as: wo or more eniies working wih all paries sharing power, being acively involved, and having a vesed ineres in he success of he projec. The poenial benefis of collaboraion among communiy healh organizaions and graduae programs in nursing for boh parners and he greaer communiy principles however, were esablished. Three ses of principles of parnership were examined and he CCPH were seleced as he frame ofreference for bes pracices in ACP as hey relaed o he curren sudy. The CCPH principles are highly ariculae and difficul o summarize; reciprociy is he dominan heme hroughou wih muual rus and respec among all sakeholders; a high level ofcommimen by all parners; and clear, open communicaion (CCPH,2000). Relaionships among organizaions have been he subjec of considerable research and heory developmen. Three frameworks of collaboraion among organizaions for

54 45 communiy healh were examined. Several research sudies of iner-agency collaboraion perspecives educaion, were discussed ha described oucomes, and facors influencing he relaionship, from he of all parners. Findings were congruen wih he principles of parnerships and included shared aims, muual rus and respec and open communicaion among all paries. Parnerships beween communiy healh organizaions and insiuions of higher including programs of graduae nursing educaion, should srive o mee he principles ariculaed by CCPH. Over he pas 14 years, he need for rigorous research in service-learning and ACPs in higher educaion has been proclaimed on several occasions. Proposed agenda indicae he perspecives ofall sakeholders including he communiy should be considered and research should examine boh oucomes as well as processes. However, his review of publicaions in he area of service-learning and ACPs in higher educaion, healh professions educaion, undergraduae nursing educaion and graduae areas and is in he early sages ofadopion for graduae nursing educaion, research has focused largely on suden oucomes. Wih he few excepions of repors from higher educaion cied earlier in his chaper, sudies ha do consider he communiy perspecive vary in rigor and are ofen evaluaive in purpose. Ouside ofhe HPSISN projec whose nursing educaion indicae his has no been he case. While he sraegies of service-learning and academic-communiy parnerships have gained widespread accepance in he firs hree he idenified purpose was evaluaion, no sudies were found of research involving undergraduae or graduae nursing programs ha gave equal aenion o all sakeholders or focused solely on communiy parner. Mos repors did indicae effors were made o address communiyneeds; one idenified a sraegy for assuring reciprociy; and a few referred o principles of service-learning and/or ACPs. However, in mos cases, i was difficul o deermine wheher reciprociy was a goal of he projec. Auhors ofen saed hey were

55 46 When where parnerships improved Reciprociy organizaions were referred o in radiional erms such as agencies or sies. repored, feedback from agencies was uniformly posiive. In he few insances commens or recommendaions concerning he process of ACPs were sough, communicaion was a clear heme. This finding is congruen wih he principles of and facors found o influence collaboraion among CHOs. is a fundamenal principle of exemplary service-learning and ACPs (Cruz and Giles, 2000). Taking acion o assure communiy-idenified needs are being me is an imporan sep bu is no sufficien o assure reciprociy or o mee he CCPH principles of engaging in service-learning bu he erm parnership was no always used and he communiy effecive parnerships. There is a need for rigorous inquiry o undersand and explain facors influencing successful service-learning and ACPs. This is especially he case for ACPs involving graduae nursing educaion where he knowledge base is small and influencing facors may be modified by he unique characerisics of graduae nursing sudens and he services hey are able o provide. This researcher sough o address he gap in knowledge of communiy parners' heory mehods ofqualiaive research o examine he perspecives ofcommuniy healh perspecives of parnership involving graduae nursing educaion. The sudy used grounded organizaions ha have parnered wih faculy and sudens in a graduae program of nursing educaion. The following secion ofhis chaper provides an overview of Glaser and Srauss' (1967) iniial Discovery of Grounded Theory approach o research and a brief summary of Secondary In furher developmens and variaions by Glaser, Srauss, and ohers. Lieraure Review keeping wih sages ofhe grounded heory approach o qualiaive research, secondary review of he lieraure focused on publicaions relaed o he descripive heory

56 47 which emerged ou of he daa analysis. Thireen publicaions were idenified: eleven heoreical publicaions (Seifer, 2002; Bailey, Carpener and Harringon, 2002; Seifer and Vaughn, 2002; Elias and Bui, 2002; Bejarano, Balcazar and Brewer, 2002; Leiderman, Furco, Parnershipsfor Zapf and Goss, 2003; Jacoby, 2003a; Jacoby, 2003b; Jones, 2003; Enos and Moron; 2003); one descripive aricle (Holloway, 2002) and one research repor (Narsavage e ai., 2002). Five publicaions perained o nursing and were included in a special issue ofhe Journal of Nursing Educaion (2002). The one research repor (Narsavage e ai., 2002), was par ofhe special issue ofhe Journal ofnursing Educaion and was included in he primary review of he lieraure as "in press". Four publicaions were chapers in a book eniled Building SERVICE-LEARNING (Jacoby, 2003). Leiderman, Furco, Zapfand Goss (2003) published he findings ofheir Sepember, 2002 naional summi of21 leaders ofcommuniy organizaions ha were currenly parnering wih insiuions of higher educaion as par of projecs funded by he Consorium for he Advancemen of Privae Higher Educaion. Discussions ook place in a "variey of formas including focus groups and work sessions" (Leiderman e ai., 2003, p. 2) and a summary ofhe summi was published in a pamphle. Leiderman e al.'s publicaion may represen a summary ofa research repor. However, he researcher was unable o locae he "complee findings" (Leiderman e ai., 2003, p. 3) Principles ofparnerships A number of he publicaions idenified in he secondary review ofhe lieraure referred o he Principles of Parnerships (discussed earlier in his chaper) as imporan resources in describing successful communiy-academic parnerships (Bailey, Carpener, and Harringon, 2002; Jacoby, 2003a; Jacoby, 2003b; Jones, 2003; Seifer, 2002; and Seifer and Vaughn, 2002). Jacoby (2003a) idenified an addiional se ofprinciples for ACPs and

57 48 Ramaley's "Lessons Learned From Exising Parnerships". Published by Campus Compac in 2000, "Benchmarks for Campus/Communiy Parnerships" buil upon he "Wingspread Principles" discussed earlier in his chaper. The Campus Compac principles are shaped around hree sages of parnership (designing, building collaboraive relaionships, and susaining parnerships over ime) and refer o "genuine democraic parnerships". Refer o Appendix C for he characerisics of each sage. Ramaley's "Lessons Learned from Exising Parnerships" "focus on he comprehensive universiy" (Jacoby, 2003a). As hey are congruen wih he oher principles and beyond he scope of parnerships examined in his projec hey will no be discussed furher. Conceps and Frameworks ofcommuniy-academic Parnerships Jacoby and Associaes (2003) addressed he need for heoreical lieraure focused on he parnership process in service-learning in heir book, Building Parnershipsfor Service- Learning. This book was a follow-up o Jacoby's 1996 book, Service-Learning in Higher Educaion: Conceps and Pracices. In her chaper on "Fundamenals of Service-Learning Parnerships", Jacoby (2003a, pp.1 and 4) cied Bailis (2000, p. 5), Jacoby (1996a) and Kendall, 1990, p. 20) in noing ha "service-learning and parnerships are wo sides of he Jacoby parnership same coin" and ha "Service-learning is a program, a philosophy, and a pedagogy. As a program, service-learning emphasizes he accomplishmen of asks o mee human and communiy needs in combinaion wih "inenional learning goals and wih conscious reflecion and criical analysis". (2003a) differeniaes parnerships from oher ypes of iner-organizaional relaionships by observing ha if all paries do no benefi, he relaionship is no a rue and noing he key facors of reciprociy and shared goals. Jacoby (2003a, p. 7)

58 49 describes" ruly reciprocal parnerships as also ermed collaboraions" and cies Maessich and Monsey (1992, p. 7) in defining hem as: A muually beneficial and well defined relaionship [ha] includes a commimen o: a definiion of muual goals; a joinly developed srucure and share responsibiliy; muual auhoriy and accounabiliy for success; and sharing no only of responsibiliies bu also ofrewards. All individuals and insiuions involved in parnerships, or collaboraions, learn abou hemselves and ohers in he process and are affeced, and likely changed, in he process. Jacoby (2003a) noed ha some auhors use he erm collaboraion, ohers use parnership and some use hem inerchangeably. She preferred o use he erm "parnership" and, for he purposes ofher book, used he CCPH definiion of parnership (see Chaper I). Enos and Moron (2003, p. 23), conribuors o Jacoby and Associaes (2003) book, build on he aforemenioned principles ofcommuniy-academic parnerships by "Developing a Theory and Pracice ofcampus-communiy Parnerships. They idenified wo ypes of parnerships and "adaped heories used o examine leadership o provide a way o examine (he developmen of) parnerships as hey move from ransacional o ransformaive" Enos and Moron (2003, p. 23).... Mos ofour service-learning and communiy service effors can be characerized as ransacional.. Our communiy service and service-learning projecs may be well managed and, we can rack and documen service hours, and we can guaranee agencies ha sudens will appear semeser afer semeser for assignmens...his is no o say hese ransacional relaionships are no imporan, be we can expec ha lile or nohing will be changed by hem over ime...(ye) From our experience, we know ha campus-communiy parnerships have he poenial o be far

59 Table I more... dynamic,join creaions in which all he people involved creae power, mix personal and insiuional ineress and meaning. Table 1 liss Enos and Moron's crieria for ransacional and ransformaive parnerships. Transacional and Transformaive Relaionships Crieria Basis of relaionship End goal Purpose Roles played by parners Suppor of exising insiuional goals Boundaries Parner ideniy Scope of commimen Transacional Exchange-based and uiliarian Saisfacion wih exchange Saisfacion of immediae needs Managers Source: Enos and Moron (2003, p. 25). Acceps insiuional goals Works wihin sysems o saisfy ineress of parners Mainains insiuional ideniy Limied ime, resources, personnel o specific exchanges Transformaive Focus on ends beyond uiliarian Muual increase in aspiraions Arouses needs o creae larger meaning Leaders Examines insiuional goals Transcends self-ineress o creae larger meaning Changes group ideniy in larger definiion of communiy 50 Engages whole insiuions in poenially unlimied exchanges Enos and Moron (2003, p. 27) suggesed a Framework for Developmen of Campus- Communiy Relaionships ha depics five ypes of relaionships, overlapping, according o wo dimensions: ime (horizonal) and deph of complexiy (verical): (a) One-ime evens and projecs, (b) shor-erm placemens, (c) on-going placemens or muual dependence, (d)

60 core parnerships or inerdependence, (e) ransformaion or join creaion of work and knowledge. Sages ofcommuniy-academic Parnrerships 51 Bejarano, Balcazar and Brewer (2002) developed "The Model for he Parnership o Address Healh Dispariies in Tarran Couny" based on heir experiences wih a muli organizaion projec in Tarran Couny, TX. The model depics a process for change wih five sages: (a) geing ogeher, (b) building rus, (c) developing a sraegic plan, d) aking acion sage and (e) going o scale. As previously noed, he Campus Compac's "Benchmarks for Campus-Communiy collaboraive Facors Parnerships" depic parnerships as having hree sages: (a) designing, (b) building relaionships, and (c) susaining parnerships over ime (refer o Appendix C for a summary of he Campus Compac benchmarks). Influencing Communiy-Academic Parnerships Facors influencing CAPs may be inferred from he various Principles of Parnerships. In addiion, several recen publicaions have idenified facors influencing he success of CAPs. Facors include: 1. The loosely coupled naure of colleges and universiies. The fac ha many colleges 2002). advanage in ha one uni may be quie successful a CAPs while anoher may no. I can be a disadvanage in ha communicaion and coordinaion may be lacking and i may be difficul o ransform or change he enire insiuion (Enos and Moron, 2. Risk and rus. Enos and Moron (2003, p. 34) observe ha CAPs exis on a coninuum of risk and benefi. The developmen of rus, "a muual undersanding of and universiies are "loosely coupled" wih relaively auonomous unis may be an

61 52 relaionship 3. universiy's o he ineress ofhe parners, ogeher wih some faih ha he parners will say in he despie obsacles or difficulies ha will surely arise" allows he parners overcome he risks involved in he relaionship. They add ha "rus canno be signed off in a conrac... i emerges gradually as a working relaionship develops". Fi. Jones (2003, p.159) saes: "There mus exis a close mach beween he objecives and inended suden-learning oucomes and he communiy organizaion's mission, aciviies, and imelines. Wihou such a mach, parnerships will always serve universiy and suden ineress firs". 4. Time. Jones (2003, p.158) noes ha "Effecive parnerships wih communiy agencies are developed over ime and ake ime o develop... Faculy and saff seeking o iniiae parnerships mus ake he ime o ruly ge o know he organizaions wih which hey would like o parner...his includes developing a working knowledge of mission, services, programs, saffing, and clienele, and is bes accomplished by spending ime on sie a he communiy agency... Leiderman e al. (2003, p. 15) advised: "allo ime for relaionship building early on, and as an ongoing par of he communiy engagemen work". 5. Communicaion. Referring o communicaion, Jones (2003, p. 159) observes: "Ofen communicaion beween universiy and communiy agency personnel focuses on process..." "seing up" he service-learning sie placemens. Afer an iniial invesmen ofime, universiy faculy and saffend o back away from he day-o-day faciliaion of he parnership...effecive parnerships wih communiy agencies are characerized by consisen communicaion and dialogue hroughou all aspecs ofhe parnership Learn how o alk ogeher abou racial, ehnic, and economic inequaliies and heir causes wih candor, and incorporae hese discussions ino

62 53 communiy/campus parnership-building work (Leiderman e ai., 2003). Elias and Bui (2002) noe ha miscommunicaion among parners can influence he success of he relaionship. 6. Aenion o power dynamics. Jones (2003) suggess ha, in order for parnerships o succeed over ime, boh parner organizaions mus have he infrasrucure and capaciy o suppor he parnerships. 7. Idenify he underlying reasons for esablishing or developing communiy/campus parnerships (Leiderman e ai., 2003) 8. Undersand he organizaional conexs in which all parnership members work 9. Colleges and universiies can invie communiy parners ono campus so hey can (Leiderman e ai., 2003) share heir experise wih faculy and sudens (Leiderman e ai., 2003) 10. Be meiculous abou he deails (Leiderman e ai., 2003). 11. Adhere o he principles of parnership (Bailey, Carpener, and Harringon, 2002) 12. Esablish a communiy advisory commiee ha conribues o developmen and evaluaion ofhe program (Bailey, Carpener, and Harringon, 2002) 13. The universiy has a key responsibiliy o nurure he parnership and place sudens who ineresed in he communiy parner's work (Bailey, Carpener, and Harringon, 2002). 14. Ensure fairness in exchange of resources among parnership members (Leiderman e al.,2003). 15. The imporance of follow-hrough for building susainable parnerships (Leiderman e ai., 2003, p. 4)

63 How communiy parners weigh he coss and benefis of parnering wih an insiuion ofhigher educaion (Leiderman e ai., 2003, p. 4). 17. Acknowledge experise. Faculy and saff from he collegiae seing recognize he conribuions communiy parners can make o suden learning (Jones, 2003). 18. Evaluaion and assessmen. Effecive parnerships mus include on-going assessmen and evaluaion wih inpu from all sakeholders (Jones, 2003). 19. Oriening new sudens each semeser (Holloway, 2002) 20. Lack of (undergraduae) sudens during summer break (Holloway, 2002). Characerisics ofsuccessful Communiy-Academic Parnerships Characerisics of successful ACPs described in he lieraure are based on auhors' descripions of long-erm parnerships ha have ofen involved several organizaions. For example, Jones (2003, p.162) describes characerisics of "sable, meaningful, maure relaionships". There is some cross-over beween influencing facors and characerisics of successful ACPs. The reader is also referred o Enos and Moron's (2003) crieria for ransacional and ransformaive parnerships as well as he Principles of Parnerships. Characerisics idenified in he secondary lieraure review include: 2. Mmuual needs are me (Jones, 2003). 1. On-going relaionships (Jones, 2003). 3. Parners collaborae in advocacy and funding proposals (Jones, 2003). 4. Sakeholders from each parnership paricipae in each ohers organizaions (Jones, 2003). 5. Responsive o communiy-idenified needs (Elias and Bui, 2002; Bailey, Carpener, and Harringon, 2002).

64 6. Respecful. Sudens need o undersand culural differences, examine heir own values, gain a sense of hisory of he communiy and parner organizaion (Elias 55 and Bui, 2002). 7. Reflecive. Sudens should explore heir own biases and preconcepions and analyze and synhesize he experience (Elias and Bui, 2002). 8. Reciprocal or win-win relaionships (Elias and Bui, 2002; Bailey, Carpener, and Summary Harringon, 2002). The secondary review ofhe lieraure elicied a number of recen publicaions concerning he opic ofcommuniy-academic parnerships. All, excep Leideman e al. (2003) are heoreical in naure and based on he auhors' experiences wih service-learning and communiy-academic parnerships. Models, ypes, sages, influencing facors, and characerisics of successful parnerships were described. Readers are admonished o "always remember ha service-learning is all abou parnerships" (Jacoby, 2003, p. 315). Overview ofthe Discovery ofgrounded Theory Barney Glaser and Anselm Srauss firs described heir innovaive approach o research, he discovery of grounded heory, in Alhough Glaser and Srauss were sociologiss, heir approach o research has had srong links o nursing from he sar. The firs sudy in which Glaser and Srauss applied he grounded heory approach concerned dying, in paricular, nurses' perspecives of dying, and was funded wih a Public Healh Service Research gran from he Division ofnursing. Several of Glaser and Srauss' early and longerm colleagues have been professional nurses and include Julie Corbin, Jeanne Benoliel, Sally Huchinson, Phyllis Sem, Janice Swanson and ohers. (Benoliel, 1996).

65 56 Grounded heory is defined as "discovery of heory from daa sysemaically obained generaion of heory o verificaion or esing ofheory and described heir approach o from social research" (Glaser and Srauss, 1967, p.1). Glaser and Srauss conrased research as a means o arrive a heory suied o is inended uses. Glaser and Srauss saw a need for more sociological heory and were concerned wih researchers who aemped o "force" an exising heory o fi new daa. If he purpose of a heory (in sociology) is o "predic and explain behavior", hen i mus "fi he siuaion being researched" and "work when pu o use" (Glaser and Srauss, 1967, p. 3). Glaser and Srauss believed he bes approach o generae a heory ha "fis and works" is o, from he beginning, sysemaically discover he heory from he daa under sudy. Glaser and Srauss (1967) viewed generaion of heory and verificaion ofheory as being independen of he mehod of daa collecion and believed ha eiher quaniaive or qualiaive daa or boh could be used for eiher generaion or verificaion ofheory. Generaion oftheory sense The developmen of grounded heory is an inducive process. "To make heoreical of so much diversiy in his/her daa, he analys is forced o develop ideas on a level of generalizaion higher in concepual absracion han he qualiaive maerial being analyzed" (Glaser and Srauss, 1967, p.114). Grounded heory research may lead o wo forms ofheory and wo ypes of middle-range heory. The wo forms include: (a) "a well codified se of proposiions or (b) a running heoreical discussion using concepual caegories and heir properies" (Glaser and Srauss, 1967, p. 31). Glaser and Srauss favored he second form as hey viewed developmen of heory as an on-going process.

66 57 research, The wo ypes ofheory are subsanive and formal. Subsanive heory is "heory developed for a subsanive or empirical area of sudy" and "formal heory is heory developed for a concepual area of inquiry" (Glaser and Srauss, 1967, p. 32). For he curren an example offormal heory would be "iner-organizaion relaionships" and an example of subsanive heory would be "academic-communiy healh parnerships involving a graduae program of nursing". Grounded heory research may lead o eiher ype ofheory bu is paricularly useful for developing subsanive heory. Glaser and Srauss cauion ha subsanive grounded heories are suggesed, no esed, and heir applicabiliy o oher subsanive areas may be limied. Applicabiliy of subsanive heory may, however, be faciliaed hrough he minimizing or maximizing ofdifferences among comparison groups Elemens ofgrounded Theory Grounded heory has wo elemens: (a) concepual caegories and heir concepual properies and (b) hypoheses (Glaser and Srauss, 1967). Caegories are he concepual elemens of he heory and properies are he (see p. 45) (Glaser and Srauss, 1967). concepual aspecs or elemens of a caegory. Boh caegories and properies emerge from he They caegories emerge early in he daa collecion process whereas higher level, overriding conceps and heir properies arise laer during join collecion, coding and analysis of daa. described wo characerisics of conceps: (a) analyic and (b) sensiizing. Analyic conceps are "sufficienly generalized o designae characerisics ofconcree eniies, no he eniies hemselves" (Glaser and Srauss, 1967, pp ). Sensiizing conceps yield a meaningful picure o he reader. daa and are no he daa hemselves. Glaser and Srauss (1967) suggesed ha lower level

67 58 Hypoheses are "generalized relaions among caegories and heir properies" (Glaser and Srauss, 1967, p. 35). A firs, hypoheses may seem unrelaed, bu wih on-going heoreical sampling and comparaive analysis, iner-relaionships will appear followed by he core ofhe emerging heory (Glaser and Srauss, 1967). Glaser and Srauss (1967) believed inegraion of grounded heory occurs a many levels of generalizaion and inegraion of heory is bes when i emerges like he conceps. Daa Collecion Through Theoreical Sampling Grounded heory research is conduced hrough he join collecion, coding, and analysis ofdaa. For purposes of clariy, daa collecion and analysis will be discussed as separae opics. Iniial decisions for daa collecion are based largely on he researchers' knowledge of he general subjec or problem area. The researcher "may begin he research wih a parial framework of "local" conceps, designaing a few principal or gross feaures ofhe srucure and process in he siuaion he will sudy" (Glaser and Srauss, 1967, p. 45). However, as he purpose ofhe research is generaion ofheory, plans for daa collecion are no based on an exising heoreical framework. Once iniial daa collecion has begun, subsequen decisions as o wha daa o collec and where o find hem are no pre-planned bu driven by he emerging heory (heoreical sampling). Researchers using heoreical sampling canno sae he number and ypes of groups from which daa will be colleced in advance, and mus be flexible in heir decisions as o which groups o include (Glaser and Srauss, 1967). In heoreical sampling, groups (aggregaes or individuals) are seleced according o wo crieria: (a) heoreical relevance and (b) heoreical purpose. Groups chosen according o heoreical relevance will furher developmen ofhe emerging caegories, help generae as

68 59 many properies of he caegories as possible, and help relae caegories o each oher and heir properies (Glaser and Srauss, 1967). Theoreical purpose refers o he generaliy of he heory and includes wo aspecs: populaion scope and concepual level (subsanive o formal). Comparison groups chosen o minimize differences (i.e. groups are sub-ypes ofhe same ype) increase he probabiliy of collecing similar daa on a caegory hus helping o verify is exisence and esablish he condiions under which a caegory exiss. Comparison groups chosen o maximize differences (i.e. differen ypes of groups) increase he probabiliy of collecing differen and varied daa bearing on a caegory as well as finding similariies among groups. If lile is known abou he subjec area and he researcher's goal is a subsanive heory, he/she will end o selec groups ha are more similar. However, he researcher who seeks o develop a formal heory would maximize differences among groups. In general, he researcher ends o minimize differences among groups a he beginning ofhe sudy and maximize differences among groups as he Muliple heory emerges (Glaser and Srauss, 1967). comparison groups promoe credibiliy ofhe heory and assis he reader o idenify is applicabiliy and limiaions. By precisely deailing he many similariies and differences ofhe various comparison groups, he analys knows, beer han if he had sudied only one or a few social sysems, under wha ses of srucural condiions hypoheses are minimized or maximized, and hence o wha kinds of social srucures his heory is applicable (Glaser and Srauss, 1967, p. 231). The grounded heory researcher mus also make decisions as o how many groups he/she should sudy and how much daa should be colleced from each group. These decisions are imporan as he grounded heory researcher, especially one conducing a large sudy, is

69 60 likely o find him/herself coninuously dealing wih muliple groups and muliple siuaions wihin each group. Daa are colleced and simulaneously analyzed unil heoreical sauraion occurs or no new properies ofhe paricular caegory are being idenified. Guided by he heoreical purpose, he researcher aemps o saurae caegories by maximizing differences among groups. This is accomplished by seeking groups ha srech he diversiy ofdaa being colleced abou a specific caegory. Glaser and Srauss cauion he grounded heory researcher ha he/she will never aain heoreical sauraion by examining one inciden in one group. The researcher will no have a heoreical sample and he associaed heory is usually hin, no well inegraed and will have oo many obvious unexplained excepions. The researcher should sample a caegory unil he/she is confiden ofis sauraion. The researcher should coninue o saurae all caegories unil i is clear which are he core caegories (hose wih he mos explanaory power) and he core caegories should be sauraed as compleely as possible. As he grounded heory researcher canno sae a he beginning of his/her sudy how many groups will be required and how much daa will be colleced from each, he/she Theoreical sampling by he grounded heory researcher doing a field sudy involves canno also no predic how long he sudy will ake o complee. (Glaser and Srauss, 1967). simulaneous reading of documens, inerviewing and observing. Inerviewing will no be a highly sysemaic and srucured process. Raher, he researcher will begin wih open-ended quesions ha encourage he paricipans o ell heir sories. Laer, inerviews and quesions observaion will be guided by he emerging heory. The researcher will ask more direc designed o elici informaion abou he emerging caegories and heir properies. Laer inerviews are usually shorer in ime and greaer in oal number. When he purpose of

70 61 heoreical sampling is o follow a siuaion over ime, sequenial observaions and/or inerviews may be required (Glaser and Srauss, 1967). Daa Analysis Through Consan Comparison In grounded heory research, he consan comparaive mehod of daa analysis is used. Through sysemaic coding and analysis ofdaa, he consan comparaive mehod generaes a heory ha is inegraed, consisen, plausible, close o he daa and in a form clear enough o be operaionalized for esing in quaniaive research (Glaser and Srauss, 1967). The consan comparaive mehod includes four seps ha end o predominae in he order lised; however, he earlier sages will remain in use hroughou he research process. Sep I: Compare incidens applicable in each caegory. The researcher codes each inciden in he daa ino as many caegories as possible. Coding of daa may elici new caegories or may fi an exising caegory. Caegories may be noed in he margins of he ranscrips or field noes or on separae cards. While coding an inciden for a caegory, he researcher should compare i wih previous incidens in he same and differen groups coded in he same caegory (rule 1 of he consan comparaive mehod). The researcher should keep a wrien record ofhe comparison group in which an inciden occurs. During he firs phase, he researcher will soon begin o generae heoreical properies of he caegory. Properies should be viewed in erms of: he dimensions ofhe caegory, condiions under which he caegory is changed, major consequences ofhe caegory, and he relaionship ofhe caegory o oher caegories. should When he researcher finds conflics in he emphases of hislher hinking, he/she sop coding, record a memo ofhislher ideas and, possibly, discuss he heoreical noion wih a colleague (rule 2 ofhe consan comparaive mehod). Memos can be wrien

71 62 direcly on he ranscrip or as field noes, along wih he code, o provide an immediae illusraion of an idea. Sep 2: Inegrae caegories and heir properies. As coding coninues, he researcher compares incidens wih incidens and incidens wih properies. Correc use of he consan comparaive mehod will cause he accumulaed knowledge concerning a propery of a caegory o readily sar o become inegraed. They will be relaed in many ways and resul in unified whole. "Thus he heory develops, as differen caegories and heir properies, end o heoreical sense of each comparison" (Glaser and Srauss, 1967, p.l09). become inegraed hrough consan comparisons ha force he analys o make some relaed Sep 3: Delimi he heory. The researcher delimis he emerging heory a wo levels: caegories and heory. As he original lis of caegories elicied from early collecion and coding of daa caegories becomes heoreically sauraed, i is modified o become more selec and focused. If, in a large sudy, a new caegory emerges afer much coding has been done, he researcher should no go back and code all previous daa for he new caegory bu sar o code for he new caegory where i emerges (Glaser and Srauss, 1967). The emerging heory is delimied by becoming solidified (fewer and fewer major modificaions) and reduced (a small se of higher level conceps). The resuling heory will hen mee wo major requiremens of a heory: parsominy of variables and formulaion and scope (applicabiliy o a wide range of siuaions). Sep 4: Wrie he heory. A his poin in he research process, he grounded heory caegories researcher has: (a) coded daa, (b) a series of memos ha indicae he conen behind he leading o he major hemes of he heory and (c) he heory. The researcher should publish he heory when he/she is convinced he analyic framework: (a) forms a sysemaic subsanive heory, (b) is a reasonably accurae saemen of he maers sudied and (c) is

72 63 couched in a form ha ohers in he same field could undersand. In wriing he heory, he coded daa is revisied o: (a) validae a suggesed poin, (b) pinpoin daa behind a hypohesis or gaps in heory and/or (c) provide illusraions. "Pinpoining" is a "procedure ha ends o be used relaively lae in one's inquiry and perains mainly o inegraing heory hrough he checking of deailed poins suggesed by specific hypoheses" (Glaser and Srauss, 1967, p. 173). Glaser and Srauss (1967) make a srong case for he role library or documenary maerials can, depending on he opic of ineres, play in he comparaive mehod ofdaa analysis. "These maerials are as poenially valuable for generaing heory as our observaions and inerviews" (Glaser and Srauss, 1967, p. 163). Early on, documenary maerials can help he researcher undersand he subsanive area he/she will sudy and may help in formulaion of early hypoheses. Laer, documenary maerials may be used for descripive analysis and he emerging heory may be compared wih exising heories. When seeking ou library maerials, he researcher should follow he same procedures no be consrained by he principal opic and is' synonyms bu be open o any maerials ha as during selecion of comparison groups for field observaion and inerviews. He/she should may have some bearing on he comparaive process. As caegories, heir properies, and hypoheses emerge, he researcher seeks ou addiional comparaive maerials ha, according o he heoreical purpose ofhe sudy, will minimize or maximize differences among groups (Glaser and Srauss, 1967). developmen comparaive Glaser and Srauss (1967) devoe considerable aenion o he role insigh plays in ofheory. They see he sensiive insigh of he researcher as he roo source of all significan heorizing. Insighs should be regarded as daa and incorporaed ino he analysis process.

73 64 Credibiliy a/grounded Theory be Glaser and Srauss viewed judging he credibiliy of a grounded heory publicaion o he join responsibiliy of he researcher and he reader. Credibiliy of a sudy is assessed hrough: (a) he exen o which readers become so caugh up in he descripion ha hey feel hey are also in he field and (b) he reader's assessmens of how he researcher came o his/her conclusions. The researcher faciliaes reader criique of he heory developmen process and reader decisions as o applicabiliy of he heory by using muliple comparison groups o increase he scope and delimi he generaliy of he heory (Glaser and Srauss, 1967). properies: (a) he heory mus fi he subsanive areas o which i will be applied, (b) he heory mus make sense and be undersandable o professional and lay persons working in he subsanive area, (c) he heory should be sufficienly general o be applicable o a muliude Pracical applicabiliy of he subsanive grounded heory is influenced by four of diverse daily siuaions wihin he subsanive area and (d) he heory should enable he user o have enough conrol in everyday siuaions o make is applicaion worh rying (Glaser and Srauss, 1967). Glaser and Srauss idenified wo challenges in he researcher's effors o convey he credibiliy of he grounded heory: (a) "geing readers o undersand he heoreical framework and (b) how o describe he daa ofhe social world sudied so vividly he readers can almos lierally see and hear is' people - bu always in relaion o he heory" (Glaser and Srauss, 1967, p. 228). To respond o he firs challenge, he researcher should include an exensive absrac of he overall framework and principal associaed heoreical saemens a beginning and/or he end of he publicaion and in segmens hroughou. To respond o he second challenge, he researcher should presen characerisic illusraions and use codified

74 65 procedures, such as he consan comparaive mehods, for analyzing he daa, which allow readers o undersand how he heory emerged from he daa. Summary Barney Glaser and Anselm Srauss, sociologiss from he Universiy of California a San Fransciso, firs described The Discovery of Grounded Theory, heir innovaive approach o qualiaive research, in The purpose ofgrounded heory research is o, hrough sysemaic collecion and analysis, discover heory from daa. The grounded heory approach may be used o develop subsanive or formal heory concerning he social sciences bu is paricularly useful for he former. Sraegies used o develop grounded heory are implemened joinly and include: (a) daa collecion hrough heoreical sampling of muliple concepual comparison groups unil heoreical sauraion is reached; (b) coding ofdaa o elici caegories, heir concepual properies and hypoheses; and (c) consan comparaive analysis of daa. When properly developed, he caegories of a grounded heory should be: (a) undersandable o researchers and laymen familiar wih he subsanive area, (b) readily applicable and indicaed by he daa under sudy (fi) and (c) meaningfully relevan o and be able o explain he behavior under sudy (work). Pos-1967 Developmens in Mehods in Grounded Theory Research Subsequen Books by Glaser and Srauss on Mehods in Grounded Theory Research Following Glaser and Srauss' iniial descripion ofthe Discovery of Grounded Theory, a number of auhors have sough o inerpre, refine and expand heir original mehods include Glaser (1978 and 1992), Srauss and Corbin (1990 and 1998), Sern (1980). Huchinson (1993), and Dey (1999). Following he 1967 book Glaser and Srauss' careers ook separae pahs. They coninued o conduc grounded heory research and each he

75 66 grounded heory mehod, however, eleven years passed before Glaser published anoher book on grounded heory research and 13 years for Srauss. Glaser's nex book on grounded heory research, Theoreical Sensiiviy: Advances in he Mehodology ofgrounded Theory, was published in Glaser sough o answer criicism ha he original book was vague in secions and lacked sufficien deail as o how o conduc grounded heory research. In addiion o explaining daa collecion, coding, and analysis in more deail, Glaser inroduced he concep of a Basic Social Process ha buil on he idea ofcore heoreical caegories (hose wih he mos explanaory power) in he original book. Srauss and his nurse researcher associae Julie Corbin published heir revisions o, and expansion of, grounded heory research in 1990 (Basics ofqualiaive Research: Techniques and Proceduresfor Developing Grounded Theory) wih a second ediion in These books "expanded he coding process so i was even more programmaic and overformularic" and did no menion he basic social process (Melia, 1996, p. 370). Glaser responded o he firs ediion of Srauss and Corbin's book wih a harsh aack (Glaser, 1992) in which he accused hem ofa number ofdeparures from he original grounded heory mehod including wriing a new mehod of qualiaive research which he referred o as "full concepual descripion" (Melia, 1996). Srauss and Corbin have also been described as deparing from grounded heory mehods as an approach o qualiaive research wih philosophical underpinnings and viewing i more narrowly as a mehod for analysis of qualiaive daa. Criique and Inerpreaion ofmehods qfgrounded Theory Research The spli beween Glaser and Srauss and he subsequen developmen of essenially wo versions of grounded heory mehods (according o which ofhe original auhors or heir

76 67 associaes one follows) has been viewed as conribuing o he "erosion" of grounded heory (Wilson and Huchinson, 1996, p. 123) and a facor in he frequen misundersanding of, and mehodological errors in, grounded heory research (Baker, Wues, and Sem, 1992 and Wilson and Huchinson, 1996). Wells idenified hree reasons for he frequen misundersanding ofgrounded heory mehods: (a) "he consan comparaive mehod is ime consuming and demanding... (b) grounded heory is a challenge for readers because i is dense and is boundaries are ofen difficul o esablish and... (c) he originaors ofgrounded heory have been largely silen wih regard o issues ha have come o dominae discussions ofqualiaive research in he pas 10 years... " (Wells, 1995, p. 35). Wilson and Huchinson (1996) described several ypes of mehodological misakes commonly seen in grounded heory research including muddling ofqualiaive mehods and mehodological ransgression. According o Wilson and Huchinson oher misakes include: Generaional erosion an undermining ofhe original canons for grounded heory research. Premaure c1osure- he under-analysis of exual or narraive daa. 3. Overly generic - an analysis ha relies on names for so-called discovered concepual processes ha are no siuaion specific. 4. Imporing conceps - he grounded heory researcher does no suspend preconcepions, disciplinary perspecives, and previous readings when examining he daa and fails o provide an original and grounded inerpreaion (1996, pp ). The las saemen is an example of he numerous inerpreaions o be found of grounded heory. I appears o conflic wih he 1967 book by Glaser and Srauss in which hey insruc he researcher no o shape he sudy around a heoreical framework bu encourage he researcher o compare he emerging heory wih oher heoreical frameworks

77 68 relaive o he opic of inquiry as par of he consan comparaive process (Glaser and Srauss, 1967). In addiion o he numerous publicaions in which Glaser and Srauss' mehods have been criiqued or inerpreed, here have been a leas wo new versions of grounded heory research (Kools, McCarhy, Durham and Roberch, 1996 and Charmaz, 2000) as well as discussion of he philosophical underpinnings of grounded heory research (he Symbolic Ineracionism school of sociology) (Annells, 1996) and is placemen in he paradigms of inquiry (Annells, 1996 and Charmaz, 2000). Ineresingly, in he 1967 book, Glaser and Unforunaely, Srauss make no menion of Symbolic Ineracionism and refer o Blumer, he originaor of Symbolic Ineracionsim, by discussing one of his works as an example ofhe difference beween he developmen and verificaion of heory and proceed, in a foonoe, o disance hemselves from Blumer (Glaser and Srauss, 1967, p. 14). Summary and Conclusions Some 35 years since Glaser and Srauss firs described heir approach o qualiaive research, grounded heory coninues o be frequenly applied, paricularly in nursing research (Benoliel, 1996). The original book was raher vague and confusing a imes and lacked deails as o how o acually implemen grounded heory research. The auhors recognized his when hey noed "because his is only he beginning, we shall ofen sae posiions, couner-posiions and examples, raher han offering clear-cu procedures and definiions, because a many poins we believe our sligh knowledge makes any formulaion premaure" (Glaser and Srauss, 1967, p. 1). Glaser and Srauss did no mainain a relaionship in which hey were able o refine and expand heir original work. Two models of grounded heory research, as well as several oher inerpreaions and versions, have evolved based on he subsequen

78 slurring 69 wriings of he original auhors. The lack of a definiive approach o grounded heory research as well as oher facors such as he complexiy ofhe process as i has evolved, has led o of grounded heory wih oher mehods and misakes in is applicaion. This researcher followed he original mehods pu forh by Glaser and Srauss (1967) insofar as possible. In siuaions where addiional guidance was needed for sudy design and implemenaion, he auhor referred o he Glaser's firs independen work (1978) and Huchinson's 1993 chaper in Munhall and Boyd on grounded heory. The Researcher's Perspecive Background In qualiaive inquiry, he researcher is ineresed in learning abou, and undersanding, anoher's world. In order o do so, he/she mus begin he process wih a selfawareness of his/her personal preconcepions, values and beliefs concerning he area of sudy. Once he researcher has achieved ha self-awareness he/she "brackes" or ses i aside so he area of sudy may be examined and undersood in an objecive manner. Brackeing is done a he beginning of he sudy and is coninued hroughou by keeping a daily journal or diary in In and which personal feelings and reflecions are noed (Huchinson, 1993). heir original work, Glaser and Srauss (1967) did no refer o brackeing. This may be because qualiaive research was in is early sages of evoluion a ha ime and brackeing had no been described and/or because Glaser and Srauss (1967) charged he researcher wih deliberaely using hislher knowledge of he area of sudy in making he iniial plans for daa collecion. No reference was made o he issue of he grounded heoris's values researcher beliefs concerning he area of sudy. However, insofar as Sally Huchinson, a nurse and early colleague of Glaser and Srauss included brackeing in her publicaion, Grounded Theory: The Mehod (1993) he sraegy was incorporaed ino he curren sudy.

79 70 The Researcher and Academic-Communiy Parnerships: Undergraduae Nursing Educaion The researcher has, as course leader and lead clinical insrucor of pre-licensure courses in communiy/public healh nursing, engaged in academic-communiy parnerships and inegraed conceps of service-learning for he pas six years. She became aware of service-learning when seeking ways o respond o suden feedback ha hey waned o have less observaion experiences and more direc involvemen in communiy/public healh nursing pracice. The researcher was also keenly aware ofhe dispariies of healh saus and access o healh care in he universiy's neighboring communiy. Service-learning and communiy campus parnerships were seen as sraegies by which suden-idenified learning needs, course objecives and communiy healh needs could be addressed. Suden and faculy course evaluaions as well as evaluaion daa on services provided indicae ha service-learning and communiy campus parnerships have become an srong believer in he benefis of service-learning and academic-communiy parnership in imporan componen ofhe researcher' courses. Over ime, he researcher has become a nursing educaion for he sudens, faculy, nursing educaion program, he communiy healh organizaion, and he communiy-a-iarge. The researcher has paricipaed in a number of educaional programs on service-learning and academic-communiy parnerships including wo sponsored by Communiy Campus Parnerships for Healh, received a gran o enhance a specific parnership, made presenaions concerning her experiences wih academiccommuniy parnerships and paricipaed in a faculy learning-circle o explore servicelearning and academic-communiy parnerships in erms of her insiuion's undergraduae program. Over he pas five years, he researcher's Healh To Go! Projec has had six parner organizaions wih an average ofhree o four parners per semeser. The researcher's

80 71 Feedback experience wih service-learning and academic-communiy parnerships has been excellen. from sudens and communiy parners has been highly posiive and has favored coninuaion ofhe projec. Views ofhe communiy parners are sough during and afer each semeser. Mos ofen, his is done by a one-o-one meeing or phone call beween a represenaive ofhe agency and he auhor. During he year, however, a brief survey (Appendix C) was used and a formal research projec, he pilo for his sudy, explored heir percepions of he parnership experience (see below). The Researcher and Academic-Communiy Parnerships: Graduae Nursing Educaion The researcher's experience wih service-learning and academic-communiy inegrae service-learning in all specialies ofher employer's graduae nursing (MSN) parnerships in graduae nursing educaion has been as manager of a funded projec o The program ( ). The MSN program is par ofhe School of Nursing of a Carnegie I, research-inensive universiy locaed in a ciy of close o 500,000 persons in he Midwes. universiy is surrounded by neighborhoods comprised largely of minoriy and lowincome individuals. Communiy healh organizaions in he universiy's area are challenged by he need o address clien populaions wih dispariies in healh saus and access o services while facing increasingly limied resources. Tradiionally, he mission of he universiy has emphasized research and educaion; however, recen imes and new senior leadership have brough increasing emphasis on service, local as well as regional, naional and inernaional. The MSN program is well-esablished and offers more han welve specialies in midwifery and nurse aneshesia. In pas years, clinical experiences (excep for he CNS in advanced pracice nursing including clinical nurse specialis, nurse praciioner, nurse

81 72 Communiy Healh Nursing specialy) ofen ook place in insiuions such as hospials or clinics and focused on he individual clien and family. Influenced by rends described earlier, he need for increased communiy-based experiences wih a populaion focus and healh promoion orienaion was idenified. Funding was secured for a wo-year projec o address his goal hrough inegraion of service-learning and academic-communiy parnerships. I was expeced ha each suden would paricipae in a leas one course wih a communiybased componen and healh needs of underserved populaions in he universiy's communiy would be me. Communiy healh organizaions wih an ineres in parnership wih he MSN program were idenified largely hrough neworking and discussions were held o muually describe organizaional needs and poenial conribuions by MSN faculy and sudens. These discussions generally occurred during bi-monhly meeings of a Projec Advisory Group. Individual course faculy and communiy agencies hen me o furher explore possible linkages. A daa-base of poenial parner agencies has been developed. Faculy and agencies negoiae a parnership according o he needs ofhe agency, he educaional focus of he course and he skills of he sudens. Sudens, working individually or in groups, work wih agency saff o develop a specific projec ha is recorded on a suden/agency/faculy agreemen form. The imeframe for mos parnerships is one semeser. However, several courses and heir faculy have parnered wih he same agency and, in all bu one insance, he same course has parnered wih he same agency each ime i has been augh. Wih Insiuional Review Board approval, evaluaion of he projec occurs during each course and has included: suden pre/pos ess, suden qualiaive feedback, and brief surveys by faculy and communiy agencies.

82 .. 73 The researcher's relaionship wih he parner agencies for he graduae sudens has paricipaed been indirec in ha she has coordinaed mailings o parner agencies and has planned and in bi-monhly meeing ofa projec advisory group ha includes several communiy parner agencies. I has been direc in ha she was acquained wih four ofhe parner agencies as she has placed pre-licensure sudens wih hem. The researcher also aended a four day Engaged Deparmen workshop as par of an invied eam composed of one communiy parner, he Projec Direcor and wo MSN faculy persons. The researcher is aware of quaniaive and qualiaive evaluaion findings from he projec, including feedback from he parner agencies and members ofhe advisory groups. Appendix D conains a copy of he Communiy Feedback insrumen. The funded porion of he projec, and he researcher's official role as Projec Manager, ended prior o he sar of his research sudy. However, inegraion of service-learning and ACPs in MSN courses and meeings ofhe Pilo advisory group wo o hree imes a year will coninue and include he researcher as member. Projec A pilo projec for his sudy was conduced during Fall-Winer, The purpose was o explore he percepions ofcommuniy agencies wih which he reseracher had parnered. The mehodological framework for he sudy was he phenomenological mehod of qualiaive research. Semi-srucured inerviews were conduced wih he key conac persons from hree parner agencies. Resuls revealed highly posiive feedback concerning benefis o boh he agencies and sudens. Paricipans praised he level of communicaion beween he agencies and he researcher parner. Recommendaions were few and included: (a) he need for a formal agreemen beween one organizaion and he school of nursing o enable a higher level of suden aciviies and (b) more services by he sudens.

83 74 I qualiaive heory The researcher also gained experience wih he design and implemenaion of a qualiaive research sudy. Key findings included: (a) he phenomenological approach o research was no fully congruen wih he research purpose and quesions, (b) i was difficul for he researcher o avoid becoming involved in he ineracion and (c) here are challenges presened by inerviewing individuals one has worked closely wih over several years. These findings were addressed in he curren sudy hough: (a) use ofhe grounded approach o qualiaive research, (b) careful aenion o inerviewing echniques and (c) use of echniques such as brackeing and journaling o promoe objeciviy ofdaa analysis, resuls and findings. Summary and Conclusions- Review ofhe Lieraure This chaper opened wih a discussion ofhe reasons for, and benefis of, paricipaion in academic-communiy parnerships by communiy healh organizaions and programs of graduae nursing educaion. An overview ofhree ses of principles for servicelearning and academic-communiy parnerships was presened. Curren lieraure peraining educaion, healh professions educaion, undergraduae nursing and graduae nursing levels was discussed and criiqued wihin primary and secondary reviews of lieraure. The dearh in knowledge concerning communiy parners' views of paricipaion in service-learning and academic-communiy parnerships and he clear need for scholarly inquiry in his area, paricularly graduae nursing educaion, were esablished. The mehods ofgrounded heory research, as proposed by Glaser and Srauss in 1967, were described and followed by a summary of subsequen wriing on grounded heory research by Glaser, Srauss and ohers. The final secion ofhis chaper presened he o communiy healh parnerships and academic-communiy parnerships a he higher

84 agencies' researcher's perspecive of, and described he seing for, his research sudy: communiy perspecives of parnership wih a graduae program of nursing. 75 I I

85 76 I Chaper III Mehods Inroducion The grounded heory approach o qualiaive research was used o answer he following quesions: 1. How do communiy organizaions describe he process of paricipaion in an 2... work academic-communiy parnership wih a program ofgraduae nursing educaion? Wha facors do communiy organizaions (COs) idenify as influencing an academiccommuniy parnership wih a program of graduae nursing educaion? Approach o Grounded Theory Research The primary source of ground heory mehods for his sudy was Glaser and Srauss' original (1967). I was supplemened wih mehods described in Glaser's 1978 book, designed o address gaps in he original work, and Huchinson's (1993) inerpreaion which builds on he original work and inegraes sraegies from boh Glaser and Srauss' laer works. In he proposal for his sudy, he researcher indicaed inenion o closely follow Huchinson's en processes. However, as he research enered he daa analysis phase, he researcher found Huchinson's processes were acually a combinaion ofechniques and seps in he ground processes,.. ino: (a) echniques used in qualiaive research and (b) seps in he research process. The discussed in deail in his chaper, include: (a) Iniial lieraure review; (b) Iniial daa collecion; (c) Phase I analysis: Level I Coding, Level II coding, Level III coding; (d) Phase II analysis: De-limi he heory; and (e) Wrie he heory. I is imporan o noe ha heory research process. The researcher adaped Huchinson's processes and separaed hem

86 77 grounded heory research is no a linear process and ha daa collecion and analysis occur concurrenly. Primary Lieraure Review The purpose of he primary lieraure review (Chaper II) was he discovery of sensiizing conceps and gaps in knowledge (Huchinson, 1993). Iniial Daa Collecion checking Sources for daa collecion included: observaion, inerviews, documens, member and a meeing of he paricipans. The purpose was o acquire large amouns of narraive daa (Huchinson, 1993). Seing, universiy Populaion 18). leas one course in graduae nursing program (MSN program) of he Bolon School of Nursing, Case Wesern Reserve Universiy from Sepember, 2000 o April, The is locaed in a large, midwesern ciy. Each organizaion was assigned a number (1 Informaion on which organizaions comprised he seing was obained, wih permission, from he Direcor ofhe MSN Program. The seing was he 18 communiy organizaions known o have parnered wih a., The populaion included he primary conac person and/or oher saff of each organizaion in he populaion. Sampling Crieria Inclusion crieria included: being a member of he populaion and he abiliy o speak, read, and wrie English. This sudy incorporaed he grounded heory research echniques of heoreical sauraion and heoreical sampling described in Chaper II. Thus, he researcher

87 78 did no se in advance a specific sample size or highly defined inclusion crieria. Raher, sampling proceeded as follows: 1. An early guideline or goal was se of inerviewing a leas one individual, preferably he primary conac person, from each organizaion in he seing (N=18). 2. This goal was no absolue bu was subjec o modificaion as daa analysis was begun and early caegories idenified (heoreical sampling). 3. A he compleion of analysis of six inerviews, no new caegories were emerging and I he iniial level ofheoreical sauraion had been achieved. 4. The goals of sampling hen became o: (a) conribue o undersanding of emerging conceps, heir properies and relaionships among hem and (b) increase he probabiliy of collecing similar daa on a caegory hus helping o verify is exisence and esablish condiions under which he caegory exiss (Glaser and Srauss, 1967). This was accomplished by coninuing o seek inerviews wih he remaining organizaions in he seing and by asking more direc quesions designed o learn more abou he caegories and heir properies. Sample Recruimen The key conac person for each agency was idenified from records of he Communiy Engagemen Through Service-Learning (CETSL) projec. The researcher approached each conac person by phone. The sudy was explained, including informed consen, quesions answered and paricipaion sough. In wo cases he primary conac person referred he researcher o anoher saff memberls who would be mos appropriae o paricipae. Alhough grounded heory research mehods recognize he value of muliple inerviews wih one paricipan, due o he imeframe for his sudy, each paricipan in his sudy was inerviewed once.

88 79 One organizaion had closed and hree key conac persons were no longer employed by heir organizaions. All key conac persons, or saff referred by he key conac person, reached by phone or (N 15) indicaed a willingness o paricipae. However, he conac persons from agencies 13 and 14 did no respond o subsequen effors o se a dae for he inerview and were no included in he sudy. Once he inerviews were underway, he researcher learned ha: 1. The key conac person for organizaion 11, who had agreed o paricipae, was no able o come and arranged for anoher saff member o paricipae. The individual had (17) 2. A second paricipan had worked wih MSN sudens while a a previous organizaion worked closely wih he suden and was willing o be inerviewed. 3. A hird paricipan saed he parnership had acually been a 3 par relaionship involving anoher agency in he seing (16). The key conac person for he oher agency was no longer employed by he agency and did no respond o an . This and inegraed all her experiences ino he inerview. paricipan spoke for he overall parnership from her perspecive. ~ 4. A fourh paricipan repored her parnership had also involved anoher organizaion in he seing which was now closed (15). Effors o reach he conac person for he closed organizaion were unsuccessful. Therefore he hird paricipan spoke for he overall parnership from her perspecive. Descripion ofsample Ofhe 18 organizaions ha iniially comprised he seing, 13 organizaions were represened in he sample of 13 paricipans (wo paricipans were employed by he same organizaion bu had separae parnerships and one paricipan had worked for wo organizaions in he sudy). Each paricipan was assigned a leer (A -M). Table 2 provides a

89 80 summary of he organizaions and paricipans. The use of heoreical sampling is described laer in he chaper. Table 2 Descripion ofparicipans Paricipan Time Wih Agency Type of Organizaion Semesers Insrucors Courses Code (years) A 4 Volunary healh I I I B 4~ Volunary healh 3 3a 3b C 4 K-12 educaion 3 I I D 5 Specialy healh care E Many Human service 2 I 2 F 5 Human service 2 I I G I 12 Human service (2) H 18 K-12 educaion I I I I 10 Volunary healh J 20 K-12 educaion 1 I I K 5 K-12 educaion 1 I I L 41/2 Specialy healh care 1 1 I M 6 Volunary healh I 1 I Average 6.0 years 1.1 sem. 1.6 ins. 1.6 crs. a 2 Insrucors co-augh; b 2 courses Included he same sudens In order o mainain confidenialiy ofhe paricipans and heir organizaions, some informaion ha migh have added deph and richness o he descripions here and in Chaper IV is repored in he aggregae or no included in his repor a all This is paricularly he case where here was jus one occurrence of a paricular characerisic or descripor.

90 81 I Types of organizaions refleced in he sudy included: volunary healh agencies (5), volunary human service organizaion (3), K-12 educaion (3); specialy healh care (2). All paricipans were women, 7 were nurses, and 11 of he 13 described hemselves as having a leadership or managerial role in heir organizaion. All paricipans saed hey had prior experience in parnerships. The paricipans' number of years wih heir agency ranged from 1l;2 o 20 and, alhough hey were no asked o sae he number of years in heir profession, i was clear from he paricipans' descripions of heir background ha each had a leas 15 years of experience in heir profession. Informaion concerning he exen of involvemen by paricipans wih servicelearning courses from Fall, 2000 (pilo of one course) o Spring, 2003 was gahered from boh he paricipans and, wih permission ofhe MSN program, from projec records. Several paricipans could no recall he deails of which semesers, course ype and faculy wih whom hey had worked. The number of semesers a paricipan had parnered wih an MSN course varied from 1-6. The number of insrucors a paricipan had worked wih ranged from 1-4 and he number ofcourses a paricipan had worked wih ranged from 1-4. Overall, he I exen of involvemen for one paricipan ranged from 1 course, 1 semeser, 1 suden o 4 courses, 4 semesers and numerous groups of sudens a 2 agencies. Seven paricipans saed hey were members ofhe Communiy Engagemen Through Service-Learning Advisory Group and responded o quesions abou i. Field Observaion Field observaion involved visiing each paricipan's agency. The purpose ofhe visi was for he researcher o demonsrae an ineres in he agency, become generally familiar wih he agency's environmen and acquire a conex for he parnership. The researcher made field noes immediaely afer each inerview. Eleven inerviews were conduced in he

91 82 paricipan's office. Two inerviews were conduced a he paricipan's homes and subsequenly followed by visis o he agency. Field noes were made following compleion of each inerview and sie visi. The Inerview Process Each paricipan was asked o selec a dae, ime and preferred locaion for he inerview. The researcher forwarded, by mail, fax or , a confirmaion of he dae/ime/place, he informed consen informaion (Appendix E) and he purpose of he inerview. In one case, a paricipan requesed o see a verificaion ofinsiuional Review Board approval. A copy of he approval memo was forwarded o he paricipan by . The researcher conduced all inerviews. A he ime of he inerview, he researcher reviewed he consen wih he paricipan, answered any quesions, elicied he paricipan's signaure, sound checked he ape recorder and requesed descripive informaion (see Paricipan Informaion Shee, Appendix E). All paricipans agreed o be audio-aped and wo ape recorders were used. The lengh of he recorded inerview ranged from minues. Time a he locaion ofhe inerview ranged from 1-1/2 hours and was spen in a our of he agency and conversaion prior o iniiaion of aping. The semi-srucured inerviews uilized open-ended quesions (Appendix D) designed o elici he paricipan's experience of parnership wih he graduae school of nursing, facors influencing he parnership, and suggesions as o how o promoe a successful academiccommuniy parnership wih a graduae program of nursing. The inerview guide was developed from he inerview quesions and Gelmon e ai's (2001) inerview guide for assessing communiy parners' views of service-learning was used as a resource. Afer he iniial six inerviews, heoreical sampling in he form of modificaions o he original inerview quesions, was used o add deph o emerging caegories and heir properies

92 83 Group Meeing Following compleion of Level III coding, he paricipans were invied o aend a meeing of he paricipans. The purpose was o mee requiremens of one funder of he research: presen he preliminary findings of he sudy and seek paricipans' feedback on hose findings. The feedback would be used o: (a) plan a program on communiy-academic parnerships for organizaions in he universiy's communiy and (b) refine findings, implicaions and recommendaions of he sudy. The meeing was held a he universiy and lunch was provided. Six of he 13 paricipans indicaed hey planned o aend; five came o he even. Meeing saff included he researcher, he universiy saff person who funded he projec, and a graduae assisan who ook compuer noes of he discussion. Afer signing a new consen which is described in he secion on Proecion of Human Righs, paricipans inroduced hemselves and he researcher gave a verbal summary of sudy findings along wih several pracical suggesions for implemening sudy findings. Paricipans were provided wih a wrien copy of he findings and ools for implemening findings. Those who aended he group meeing found he sudy findings o be highly reflecive of heir perspecives of parnership wih a graduae nursing program. They expressed surprise a he researcher's abiliy o synhesize he conen of he inerviews. Some paricipans poined o areas of he findings hey paricularly suppored; here were no addiions or deleions. Paricipans believed he ools provided by he researcher would be The and helpful in working wih MSN sudens. funder asked paricipans o alk abou he roles hey had played in evaluaion reflecion. Paricipans indicaed hey believed evaluaion and reflecion were imporan and ha communiy parners should playa role in boh. However, hey noed ha in heir

93 84 work wih he MSN sudens hey had no been involved in suden reflecion a all and he evaluaion, which was informal, hey had done was wih faculy. The paricipans indicaed hey would be ineresed in hearing he sudens' perspecives of he projecs. Documens Daa collecion also included documens such as a brochure describing a paricular agency's hisory, mission, and services; a newsleer or an annual repor; and maerials reurned following member checking. Daa Managemen The researcher reviewed field noes and lisened o he audioapes ofhe inerviews immediaely following he inerview. Verbaim ranscrips were made as soon as possible using he word processing program Microsof Word There were no cases in which paricipans had o be conaced following he inerview o clarify any unclear saemens. The ranscrips were yped double-spaced, wih a large margin for researcher noes, numbered lines, page numbers and headings. In an effor o ransfer he enor ofhe inerview o he ranscrip, changes in one ofvoice were noed in parenheses (e.g. laughed or voice faded away); and pauses were noed wih a period (.). Field noes, ranscrips and oher lieraure from he paricipaing organizaions were sored in ring binders organized according o he order in which he inerviews were conduced. Paricipan Informaion Shees were sored in a separae binder. Audioapes, compuer files, and wrien records peraining o he sudy were sored in Daa hrough he manner described in he Proecion of Human Righs secion ofhis chaper. Analysis In he grounded heory mehod ofqualiaive research, he purpose of daa analysis is, inducive reasoning, o move from he bis of daa derived from individual

94 85 paricipans o a highly refined se of caegories and heir heoreical properies ha are generalized o he poin hey "designae characerisics ofconcree eniies, no he eniies hemselves" (Glaser and Srauss, 1967). As Glaser and Srauss acknowledged, heir 1967 work lacked specificiy as o specific seps ofgrounded heory daa analysis. This researcher relied on he procedure described by Huchinson (1993). However, as noed previously, even hose componens ofhe process were found o be somewha awkward as hey seemed o alernae beween seps oward increasingly refined caegories and echniques for achieving hose caegories. The following discussion of mehods used for daa analysis in his sudy is divided ino wo secions: (a) echniques used and (b) a sepwise se ofhree phases of refinemen and synhesis ofhe emerging caegories and heir properies: (a) coding, (b) delimiing he heory a wo levels: caegories and heory and (c) wriing he heory. As daa analysis begins wih he earlies daa collecion, he sages of daa analysis, as well as he sages ofcoding discussed below, are no linear and are likely o overlap. Techniques ofdaa Analysis According o grounded heory procedures, he researcher did all coding and began o code daa as soon as i was available. Seven echniques described by Glaser and Srauss (1967), Glaser (1978) and Huchinson (1993) were used: (a) open coding, (b) consan comparison, (c) memoing, (d) soring, (e) heoreical sampling, (f) heoreical sauraion and (g) member checking. All processes were used hroughou daa analysis. However, each Theoreical ended o dominae in developing a specific level of codes. Open coding, consan comparison, memoing, soring, and member checking are discussed under Phase I: Coding. sauraion is discussed under Phase II, Delimiing he Theory.

95 86 Phase I: Coding Coding, no menioned in Glaser and Srauss' iniial work, bu laer seen as he fundamenal echnique of daa analysis, refers o idenificaion of emerging caegories, heir properies and iner-relaionships. The ulimae goal is o idenify a Basic Social Psychological Process (BSP) and is' relaed properies. The BSP and is' properies are "grounded" in and derived from he daa. BSPs are discussed in deail laer in his chaper. Coding, along wih heoreical sampling and consan comparison, led o hree levels of codes: Level I (in vivo or subsanive), Level II (caegories) and Level III (heoreical Techniques Usedfor Coding consrucs) (Huchinson, 1993). Open coding was used for iniial daa analysis and led o Level I codes. Daa were "fracured" or examined line by line o idenify as many caegories and heir properies as possible. During open coding, he researcher asked he following quesions: "Wha is his daa a sudy off", "Wha caegory does his inciden indicae?", "Wha (process) is acually happening in he daa?" (Glaser, 1978, p. 57). In consan comparison, one inciden is compared wih oher incidens o ensure hey are muually exclusive and cover he behavioral variaion. Consan comparison is a key echnique in developing level II codes. The resul is a number ofcaegories. Memos were a sponaneous means of recording insighs as o he heoreical ideas abou he codes and heir properies. Memos were no final and were modified as needed. An example of a memo was: Paricipans have had varying degrees ofexperience wih academic-communiy parnerships. Those who have been involved for more han one semeser use ha experience o modify heir aciviies wih laer groups of sudens. Those who have

96 worked wih sudens for one semeser indicae hey would do hings differenly he nex 87 ime based on heir experiences during ha semeser. As a fund of memos ha described emerging caegories, heir properies and relaionships was accumulaed, he researcher began he soring process. The memos were sored ino Level III codes (heoreical consrucs) ha refleced he researcher's heoreical sensiiviy and buil on her knowledge of and experience wih he opic. "Theoreical consrucs concepualize he relaionship among he hree levels of codes" (Huchinson, 1993, p. 197) and is grounded in, he daa. and, as hey are based on subsanive or heoreical codes, assure he heory emerges from, Member checking involved seeking feedback from paricipans as o findings of individual inerviews as well as findings ofhe overall sudy. This provides suppor for he correcness ofhe findings and is a key sraegy in promoing rigor of he sudy. Member checking was used during Phases I and III of he sudy and deails ofhe procedure followed are discussed in hose secions. An example of he daa analysis process may be found in Table 3. Level I Codes The primary processes used o develop Level I codes were open coding and member checking. The produc of open coding was a summary of he inerview. Member checking proceeded as follows: each paricipan received a copy of he summary and was asked o review he summary, decide wheher i refleced heir houghs, wrie a noe on he summary and reurn i in an enclosed, self-addressed samped envelope (see Appendix D for a copy of he leer). Ten of he 13 inerview summaries were reurned. Eigh agreed he summary accuraely refleced heir houghs and made no changes, addiions or deleions. One paricipan who was working wih a group of sudens a he ime of he inerview added a

97 88 Table Example ofdaa Analysis Quoe from Paricipan Level I Code Level II Codes Level III BSP and Consruc 379 I hink i's very Service should Planning So while I would be happy o go alk abou he school 503 down here, cliens. imporan o Address needs ha arise from he geing o know The person you are providing he service o mee needs of a agency's cliens "I hink in his Sudens should paricular case i is come o he bes for he agency sudens o come here 494 Because I hink Sudens should you have o see and mee he cliens inerac wih he (cliens) 495 and see hem in heir... environmen 496 o ge a sense of how we approach (our services) here and he naure of he (cliens) and of he needs.. I I hink you don' ge ha sense unless you spend some ime here.." Sudens should learn abou he cliens and heir needs Paricipan is wiiiing o come o he school of nursing Condiions BSP: Connecing for Parnership Recommendaion Consruc 1: Teaming Up Orienaion of sudens Facors Influencing Parnership brief updae and one correced several inaccuracies in he descripion of her agency and

98 89 Level II Codes The purpose of Level II coding is o reassemble he Level I codes a more absrac level. The produc of Level II coding is a se ofcaegories and responses o he research quesions. The primary echnique used during Level II coding was consan comparison. The Level II coding process proceeded as follows. A copy ofeach inerview summary was cu ino individual saemens. The saemens of a similar naure or opic were pu ino Level piles on a able. Each saemen was compared o previous saemens o deermine if i was similar or differen. Saemens ha differed were pu ino a new pile. Saemens ha seemed o be relaed were hen pu ino business envelopes. Each envelope was marked wih a one hree word label ha described he phrases in ha envelope, i.e. Roles or Evaluaion. The resul was a oal of 32 envelopes. The phrases conained in each envelope were hen aped o pieces of paper which were assembled in a ring binder and secioned according o he label i.e. 21 secions or caegories. III Codes The purpose of level hree coding is o refine he emerging caegories ino heoreical consrucs along wih heir properies and relaionships. The final produc of Level III coding is he discovery of a core variable, or basic social psychological process (BSP). Primary echniques used during level III coding included soring and memoing. Glaser's (1978, p. 74) coding family, "The Six C's", was used o develop Level III coding (as described in Table 4). To accomplish Level III coding, he researcher deermined ino which of five C caegories (co-variances was no used) he nineeen Level I caegories would fi She hen re-organized he shees of paper wih phrases aached o hem ino he six C caegories. The researcher found coding according o he 6 C's o be an awkward process akin o

99 Table 90 The Six C's Coding Family Code Descripion Causes Wha is he cause ofhe BSP? Conex Wha is he seing where he BSP occurs? 4 Coningencies Consequences Upon wha is he BSP coningen? Wha are he oucomes of he BSP? Co-variances Includes conneced variables wihou forcing he idea of cause. Condiions (or qualifiers) Wha facors are essenial for acualizaion of he BSP? (Adaped from Glaser, 1978; Huchmson, 1993). "forcing a round peg ino a square hole". Some caegories fell easily ino one ofhe codes, while ohers seemed o be a weak fi or were orphaned from a code. Coding according o he 6 C's did assis he researcher in beginning o see he caegories as a process and o idenify properies associaed wih he caegories. As suggesed by Glaser and Srauss, he Level III coding process led o idenificaion of a Parnership" Basic Social Psychological Process: Connecing for Parnership. "Connecing for had several of he characerisics of a BSP described by Srauss (1978, p. 36): (a) i recurred frequenly in he daa; (b) i linked he various daa ogeher; (c) i explained much of he variaion in he daa; (d) i had implicaions for a more general or formal heory. analysis. Selecive Coding Based on he Basic Social Psychological Process (BSP) Once he BSP, Connecing for Parnership, emerged, i became he focus ofhe daa Theoreical sampling, coding, consan comparison, memoing and soring focused on enhancing he researcher's undersanding of collaboraion. As described by Huchinson (1993), he resul of selecive coding for collaboraion was six heoreical consrucs, heir caegories, and properies.

100 91 Phase II: Delimiing he Theory Following coding, he second phase of grounded heory daa analysis is de-limiing he heory. As he researcher noed ha no addiional daa were being found ha added properies o he caegories elicied during coding, hey were modified o become more During his phase, he researcher synhesizes he emerging heory a wo levels: focused. This process is referred o as "heoreical sauraion" (Glaser and Srauss, 1967). daa caegories and heory. As described by Glaser and Srauss (1967), he produc of Phase II of analysis of was an emerging heory ha was increasingly solidified (fewer major modificaions) and reduced (a small se of higher level conceps). The researcher's decision as o when o end he sudy was guided by effors o achieve heoreical compleeness or heoreical coverage as well as pracical limiaions of ime, energy, money and he research siuaion iself. The researcher believes ha, given he seing (i.e. his sudy refleced only he perspecive of he primary conac persons of he communiy parners and did no include oher sakeholders) and oher pracical consrains, an opimal level of heoreical compleeness was achieved. Phase III: Wriing he Theory Phase III of daa analysis began once he BSP was idenified, heoreical sauraion of caegories, heir properies and iner-relaionships reached; and heoreical compleeness achieved. During he hird phase ofhe daa analysis, he researcher endeavored o inegrae parnership wih a graduae program of nursing. In accordance wih Huchinson's view of he codes, caegories and consrucs ino a subsanive heory of communiy organizaions' heory grounded heory daa analysis, he researcher endeavored produce "a dense, parsimonious covering behavioral variaion" wih a descripion ha included is associaed properies, condiions, sraegies, and consequences (Huchinson, 1993, p. 206).

101 1. 92 Boh Huchinson (1993) and Glaser and Sraus' (1967) saw he oucome of Phase III daa analysis as a publishable piece of research. Glaser and Sraus suggesed he researcher is ready o publish he oucomes ofgrounded heory research when an analyical framework exiss ha: (a) forms a subsanive heory, (b) is a reasonably accurae saemen ofhe maers sudied and (c) is couched in a form ha ohers in he same field could undersand. This researcher believes she was able o accomplish he oucomes Glaser and Srauss and Huchinson described for Phase III ofhe daa analysis. Discussion of he subsanive heory along wih is caegories and heir properies and ineracions may be found in Chaper IV. Techniques used during phase III included: Revisiing he daa and using hem o: (a) validae caegories, heir properies and ineracions, (b) pinpoin daa behind a hypohesis or gap in he heory and 3) provide illusraions. 2. Member checking: a summary ofhe final resuls ofhe sudy was sen o all paricipans along wih a leer of explanaion and a samped, self-addressed envelope. Paricipans were asked o review he summary and reurn i signed wih heir reacions. Appendix D conains a copy of he leer sen o paricipans. 3. Secondary Lieraure Review. The researcher engaged in secondary lieraure review o idenify lieraure ha "suppors, illuminaes, or exends he proposed heory" (Huchinson, 1993, p. 195). Inegraion of he secondary lieraure review is included in Chaper II. Proecion ofhuman Righs Ehical Issues in Qualiaive Research Sreuber and Carpener (1999) idenified several aspecs of human righs proecion ha require special consideraion in qualiaive research. Firs, due o he evolving naure of

102 qualiaive daa collecion, infonned consen may be difficul, ifno impossible o obain. Second, in qualiaive research, he naure of paricipan recruimen, daa collecion and 93 reporing is such ha i may be difficul o assure anonymiy. However, here are acions he researcher can ake o proec confidenialiy as much as possible. Third, as he daa collecion ool, he researcher may develop a close relaionship wih he paricipan and fourh, sensiive issues may arise ou of he inerview. Fifh, he researcher has an obligaion o mainain an nursing, objecive sance hroughou he sudy. The researcher found she was able o mainain an objecive sance during he inerviews. However, she did find ha, a imes, her ineres in he opic overook her focus on he paricipan's views and she began o engage in a discussion of he opic wih he paricipan. In hose siuaions, he researcher redoubled her effors o focus he ineracion on he paricipan's views of he issue. Poenial Ehical Issues in his Seing Insofar as he researcher is also a member of he faculy of he graduae program of has played a key role in he funded porion ofhe CETSL projec, and may be inerviewing boh key leaders and mid-level saff a he same parner agencies, paricipans may have had concerns abou he confidenialiy of infonnaion hey shared during he inerview. Sraegies o Proec Human Righs The following sraegies were employed in he curren sudy in order o proec human righs, in paricular, he concerns noed above. Firs, approval of he Case Wesern Reserve Universiy Insiuional Review Board was obained prior o iniiaion of he sudy (Appendix E).

103 94 Second, each paricipan was old of he infonned consen process during recruimen and provided wih a copy of he consen fonn prior o he inerview (Appendix E). All quesions were answered. The opporuniy o aler consen was available hroughou he inerview. No paricipans chose o follow his course. during he inerviews was oally confidenial and would no be shared wih faculy, sudens, Third, o proec confidenialiy, paricipans were assured ha infonnaion revealed or oher saff a heir agency or any oher agency. Audioapes were made only wih consen of he paricipan and were coded as o agency (number) and paricipan name (leer). A shee wih descripive infonnaion for each paricipan was kep in a binder separae from he ranscrip and he descripive infonnaion was used for aggregae saisics only. Every effor was made o assure ha he wrien repor, and any publicaion or presenaion ofhe findings, would no conain paricipan's names or he names and locaions ofheir agencies. Any quoes have been modified so ha he paricipan and/or heir agency could no be idenified. responses perspecive The audioapes, ranscrips, and signed infonned consen forms are kep in a locked file, accessible o only he researcher and hesis supervisor. Compuer files are password proeced. All maerials associaed wih he sudy (i.e. audioapes, compuer files, field noes, paricipan infonnaion shees, ranscrips and consen forms) will be reained for hree years following he las publicaion associaed wih he sudy and hen desroyed. In he case ofhe group meeing, an addendum o he IRB approval was requesed and obained (Appendix E). Those who had been inerviewed for he sudy were conaced, informed of he purpose ofhe group meeing and asked o paricipae. All individual inerview summaries were mailed and received prior o he group meeing. Fourh, o promoe objeciviy and findings rue o he daa, he researchers' was discussed in Chaper II and he following sraegies were employed during

104 95 he sudy: (a) personal pre-concepions, values, and beliefs were brackeed during he proposal process as described in Chaper II, and in a diary, (b) a second researcher familiar wih he opic reviewed he daa and verify caegories, and (c) summaries of he individual inerviews as well as he overall sudy findings were sen o he paricipans so hey migh Lincoln review he i accuracy and compleeness (member checking). The researcher also kep journal in which personal feelings and reflecions were noed. Fifh, if issues of concern o he paricipan arose during he inerview, such as suggesions as o ways o improve he parnership, he researcher was prepared o discuss wih he paricipan, following he close of he inerview, means by which hey could be aced upon while proecing he confidenialiy of he paricipan-researcher relaionship. No such issues arose during he inerviews. Rigor Rigorous research is characerized by ruh value, applicabiliy, consisency and neuraliy (Lincoln and Guba, 1985). In quaniaive research, crieria used o assess hese characerisics are inernal validiy, exernal validiy, reliabiliy and objeciviy, respecively. and Guba (1985) propose four characerisics of qualiaive research ha exemplify rusworhiness (credibiliy, ransferabiliy, dependabiliy, and confirmabiliy) and sugges sraegies researchers can implemen o promoe he rusworhiness of heir research. Qualiaive Firs, Credibiliy research ha demonsraes "ruh value" is characerized by credibiliy. The sudy inegraed he following hree sraegies suggesed by Lincoln and Guba (1985). aciviies were employed o increase he likelihood of producing credible findings: (a) prolonged engagemen o provide scope (sufficien ime o learn he "culure", o es for misinformaion inroduced by disorions of he self or he respondens, and o build rus); (b)

105 96 persisen observaion o provide deph; and (c) riangulaion of mehods and heories. Lincoln and Guba (1985) also sugges riangulaion of sources. However, due o limiaions The second sraegy used o promoe credibiliy was peer debriefing. The researcher of ime and scope, here was one source for each parnership in his sudy. wih he chair of her research commiee who is a skilled qualiaive researcher. The commiee chair also reviewed he researcher's coding on wo inerviews. A wrien record of hese aciviies became par of he audi rail. explored her houghs abou he daa collecion/coding/analysis processes by discussing hem The hird, and mos imporan, sraegy o ensure credibiliy was member checks. Formal member checking was implemened by asking paricipans o reac o a summary of heir inerview as well as a summary of he overall findings of he sudy. Transferabiliy Transferabiliy corresponds o applicabiliy or exernal validiy in quaniaive research. The researcher faciliaed his decision by providing "hick descripion" (Lincoln and Guba, 1985, p. 316). "Thick descripion" involves direc quoaions aken from he Dependabiliy Dependabiliy corresponds o consisency or reliabiliy in quaniaive research. A dependabiliy audi can be inegraed wih a confirmabiliy audi (Lincoln and Guba, 1985). Conjirmabiliy Confirmabiliy corresponds o neuraliy or, in quaniaive research, objeciviy. The paricipan inerviews or field noes illusraive of he codes, caegories, or consrucs ha emerge during he process of daa analysis. The reader is also provided wih a general descripion ofhe paricipans and heir organizaions. fundamenal sraegy for assuring confirmabiliy is he confirmabiliy audi. If necessary, he

106 97 maerials will, a he compleion ofhe sudy, be made available o an independen audior familiar wih he opic of ineres for audi ofhe sudy: 1) raw daa including apes, field noes, and oher documens; 2) ranscrips of inerviews and wrie-ups of field noes wih codes; 3) memos; 4) drafs and he final repor; 5) process noes including mehodological noes and audi rail noes; 6) maerials relaing o inenions and disposiion including he inquiry proposal, personal noes and expecaions; and 7) insrumen developmen This chaper delineaed he mehods ofhe grounded heory approach o qualiaive research used in his sudy, measures aken o proec human righs, and sraegies o assure rigor ofhe sudy. The researcher's original inen was o follow Glaser and Srauss' (1967) grounded heory mehods as refined by Glaser (1978) and Huchinson (1993). However, he informaion including pilo forms and preliminary schedules (Lincoln and Guba, 1985). Summary researcher found hese mehods o be somewha cumbersome modified hem o he naure of his sudy while preserving Glaser and Srauss' original inen o have he resuling heory be inducive, subsanive, and, mos imporanly, "grounded in he daa".

107 Chaper IV Resuls Inroducion 98 This qualiaive sudy of communiy organizaions' perspecives ofparnership wih a graduae nursing program included 13 paricipans. Daa were obained hrough inerviews, field noes, agency brochures, and a group meeing. The resuls discussed in his chaper were derived from inerviews, field noes, and agency brochures. Resuls will be repored as caegories, conceps, and a descripive heory. Responses o he wo research quesions se ou in Chaper I will be addressed: 1. How do communiy organizaions describe he process ofparicipaion in an academic-communiy parnership wih a graduae nursing educaion program? 2. Wha facors do communiy organizaions idenify as influencing parnership wih a graduae nursing educaion program? Supporing quoes have been single spaced and edied for clariy. To promoe confidenialiy, any idenifying informaion has been changed and replacemen erms are in parenheses. Resuls oflevell Coding The resuls of Level I coding consis of he key poins ha emerged from each of he 13 inerviews - e.g. a summary ofeach inerview (Appendix F). To proec confidenialiy, some informaion abou he paricipans, which migh have added richness and deph o he findings, is repored only in he aggregae (Chaper III) or has been omied. Ten ofhe 13 paricipans (77%) responded o he summary which had been mailed o hem. One

108 paricipan was laid off from her agency during he sudy. Eigh of he 10 paricipans who responded found he summary o accuraely reflec heir inerview and made no correcions, addiions or deleions. One paricipan noed she had no ye received he sudens' plan for heir projec. Two oher paricipans (L and M) correced inaccuracies in he descripions of heir organizaions. Resuls ojlevel II Coding The Level II resuls (Table 5) include weny caegories. Each caegory is comprised of a group of phrases ranging from a few phrases o a large number of phrases aken from he inerview summaries. The Level II codes were shaped largely by he inerview quesions. A his poin he caegories had no been sored oher han in alphabeical order. Two early observaions abou he level II codes, noed in memos, were: (a) some codes appear relaed and can be combined ogeher and (b) paricipans' experiences wih a paricular aspec of he relaionship and suggesions as o how o improve ha aspec migh be in he same or separae codes/caegories and could be inegraed in a new caegory. Following idenificaion of he Level II codes, he researcher answered he wo research quesions. Research Quesion I: How do communiy organizaions describe he process ojparicipaion in an academic-communiy parnership wih a graduae nursing educaion program? Paricipans were clear as o heir overall saisfacion wih he parnership experience. Twelve of he 13 paricipans indicaed hey were highly saisfied wih he overall experience. While four paricipans repored he process had gone very smoohly, he remaining nine paricipans noed ha, while hey were pleased wih he oucomes, he process had is ups 99., and downs. This is paricularly he case for paricipans who had worked wih muliple groups

109 Table 5 Level II Codes Code Descripion 1. Advisory Group Views ofcetsl Advisory Group by hose who aended 2. Communicaion Communicaion wihin parnership 3. Evaluaion Experiences wih evaluaion in parnership 100.' 4. Prior parnerships Previous experiences wih parnerships & service-learning 5. Follow-up Pos-semeser follow-up repored by paricipans 6. Implemenaion Descripions of implemenaion phase 8. Iniiaion How paricipans linked wih MSN program & S-L 9. Lessons learned Wha paricipans would do differenly if parner again 10. MSN sudens Differences beween MSN & undergraduae sudens 11. Orienaion of Orienaion o service-learning, MSN program, communiy parner suden learning objecives 12. Orienaion of sudens Orienaion of sudens o communiy organizaion 13. Oucomes Oucomes ofhe parnership 7. Influencing facors Condiions seen as influencing success of parnership 14. Paricipans and heir Descripions ofhe organizaions and paricipans' roles in organizaions he organizaion. 15. Planning The process of planning suden aciviies 16. Posiives Wha wen well wih he parnership 17. Problems/Challenges Difficulies encounered wih he parnership 18. Purpose Why paricipans parnered wih MSN program; expecaions 19. Recommendaions Suggesions for how o improve parnerships 20. Roles The variey of roles paricipans played in he parnerships i

110 101 semeser. of sudens wihin a semeser, wih muliple courses and/or he same course for more han one The inerviews revealed ha paricipans' relaionships wih he MSN program followed a basic sequence hrough a semeser. However, heir responses o quesions were no linear and included references o various aspecs of he parnership. In order o provide clariy of he process for he reader ye acknowledge ha daa analysis was only a Level II coding when he research quesions were answered, he paricipans' descripions ofhe parnership process have been divided ino very basic segmens progressing hrough he ypical imeframe for projecs done by a group of sudens. Paricipans who had worked wih same.; There were a few insances in which projecs were coninued ino a second semeser by he or a differen group of sudens. Naure ofhe Parners Analysis revealed ha many ofhe paricipans shared cerain characerisics. All sudens over more han one semeser were invied o compare/conras heir experiences. were highly experienced in heir professions and all bu one had been wih he organizaion for more han four years. Seven of he 13 were nurses; he remainder was educaors or held * sudens. leadership posiions in volunary healh and human service organizaions. All had a broad undersanding ofheir organizaion's mission, services and saff. All paricipans repored some previous experience wih collaboraive aciviies and several indicaed hey were able o apply lessons learned o heir work wih he MSN Nine paricipans, including he seven associaed wih volunary healh or human service agencies, saed ha collaboraive aciviies were an inegral par of heir organizaion's work. They saw collaboraion as a key sraegy for implemening heir missions and goals, paricularly in he curren climae of diminishing financial suppor.

111 in he pas Paricipan B shared: "We are simply here o mee he needs bu no jus in a band-aid fashion. We are also very much advocaes and we work very closely wih a number oforganizaions rying o seek some fonn of healh care for everyone..." Twelve ofhe 13 paricipans saed hey had had some conac wih nursing sudens providing clinical experiences or speaking o sudens abou heir organizaion, Three paricipans repored having been involved wih service-learning and wo repored 102 having worked wih graduae nursing sudens. Several paricipans specifically noed heir ineres in supporing learning experiences for sudens. Iniiaion o/he Parnership Twelve ofhe 13 paricipans became involved hrough some conac iniiaed by faculy ofhe MSN program. In five cases, he agency was approached by he faculy member (four) or suden (one). In six insances, he paricipans had prior relaionships wih he school ofnursing (i.e. clinical sie) or universiy (i.e. AmeriCORPS sie). They were invied o be iniial members ofhe MSN program's service-learning advisory group (CETSL Paricipan Advisory Group) or aended an MSN program-sponsored insiue on service-learning and linked wih faculy hrough hose meeings. The welfh paricipan became involved when asked o provide a clien group for a projec being done by an exising parnership beween anoher organizaion and faculy member. In he hireenh case, he paricipan conaced he school of nursing for assisance wih a projec she was planning, joined he CETSL Advisory Group and hen linked wih a faculy member. E was conaced by he faculy person: "Feels like I received a blank and brand new phone call from a person I had never heard of before in her life and her name was (name) and she was saying ha she had his group of graduae nursing sudens who she waned o be exposed o he communiy and ha made fanasic sense o me...,".

112 103 Orienaion ofeach Parner Orienaion ofeach parner o he oher's organizaion was infonnal and he exen varied wih he paricipan and faculy. The discussions ended o be in person, alhough some were done by phone or . Paricipan F explained: " I don' hink a ha ime she knew compleely wha our organizaion was bu she came o learn abou our organizaion and hen made ha connecion... (My orienaion) was mosly siing down wih (faculy name) and alking over wha i is and reading hrough some ofhe informaional hings... I ook a while for me o realize ha i was bigger han jus us doing i". Generally, he faculy persons ook he lead in shaping he parnership. However, in he wo cases in which he paricipan had worked wih several courses, she ook he lead in oriening he faculy person. Paricipan B observed ha one faculy member was new o service-learning and had some reservaions abou he projec. Is There A Fi? "Because I've had some experience...1 hink I was able o have a dialogue wih her and alleviae her anxiey...kind ofcarry her a lile bi and Lgave her some examples ofsome ofhe hings we've done...and I fel really good abou ha. Unforunaely, I've no been able o mee her because we keep missing each oher. I'd like o believe ha as a resul ofha she feels...much more aware and posiive. Once he paricipan and faculy person had me and oriened each oher o heir organizaion, hey deennined wheher he parnership was a fi. Paricipan M noed ha he faculy person iniially conaced anoher person a he agency and was referred o her: "The parnership wih (anoher organizaion) already exised... because I was (providing services here). So i was he logical connecion and being an (FPB alum) myself..ha connecion was here... you know, I've always been ineresed in helping sudens learn so i was jus a naural parnership o begin wih... Alhough mos paricipans did no repor specific discussions wih heir faculy parner as o he purpose ofhe parnership, hey all had clear houghs as o he purpose/s of he parnership or heir expecaions. Two primary purposes emerged: (a) providing Purpose ofhe Parnership

113 I and is services. Paricipan B noed: "I am very passionae abou nursing in general...and I'll never forge where I came from when I was a suden and how challenging i is o be a suden... and so I remember going hrough ha adjusmen of wha you learn in school and wha's really ou here...his provides me wih an opporuniy o personally and professionally o help hose sudens see... hese are some of he kinds of hings ha you acually are gonna be dealing wih and I hink i's a wonderful opporuniy o be involved in ha and o share wha I have learned and he hings ha I have o do..." 104 communiy-based learning opporuniies for he sudens and (b) addressing needs of he paricipan's organizaion. Several paricipans focused on one ofhe primary purposes, whereas paricipan C described how she saw he wo purposes moving beyond a parallel relaionship and combining ino a single, shared goal: "In he beginning before i was really implemened I saw i as an opporuniy for (MSN) sudens o have a learning experience in a communiy seing. Bu as ime has gone on...i acually is more of like a symbioic relaionship where here is some muual benefi...in he beginning i..seemed one way. Now i seems more of a wo way relaionship and he degree o which i is wo way depends upon planning, a commimen on he par of boh paries and how he learning aciviy for he (nursing sudens) plays ou". Several paricipans menioned one or more secondary purposes for he parnership: (a) o promoe personal challenge, fulfillmen or growh for he paricipan, (b) o develop fuure healh professionals, (c) o provide opporuniies for sudens o learn abou he agency agency o learn he same informaion noed above, have a our and, in a few insances, observe agency provision of services. In some cases, all sudens were involved in orienaion. However, here were a few cases in which he paricipan's only conac was wih one or a few sudens and hey did no Suden Orienaion Orienaion of sudens o he paricipans' organizaions varied as o locaion and exen. Some paricipans came o he school and did a presenaion o he sudens abou heir organizaions' missions, services and projec needs. In oher cases, he sudens visied he

114 105 mee he oher sudens unil he culminaion of he projec. Several paricipans saed hey fel ha alhough hey knew MSN sudens are very busy and have complex lives, he sudens' orienaion o he organizaion was very limied (e.g. o he specific projec hey would do). In hose siuaions, sudens did no gain an appreciaion ofhe scope ofhe agency's services, where heir projec fi in and/or he naure, including culural perspecive, ofhe organizaion's cliens. In some cases, his lack oforienaion was seen as having a negaive influence on he oucomes ofhe sudens' projecs. Paricipan H noed: "In my specific case, i (orienaion) did no go oo well. Par of i had o do wih he sudens didn' seem o have he ime...hey sen ou one of he hree, hey sen one person, and i was hard o explain o hem wha our srucure is because i was foreign o heir way ofhinking. I hink hey had a real sruggle o find ou ha hey could no plan an eigh week course and do i in one hour... I hink i depended on which group of sudens hey were...and i was my firs ime..they sruggled a lile bi because hey were having rouble alking a he level ofhe sudens". Paricipan J commened on he imporance of sudens undersanding he naure of he organizaion's services and cliens and recommended a specific book on povery: "In alking wih he sudens..some ofhe sudens (who are) from suburban, you know middle class homes, i's raher difficul for hem o really...undersand wha some ofheir issues are wih a lo ofour populaion of(cliens) in Cleveland...his (resource) would really serve o help hem o learn a lile bi more abou he primary populaion ha hey are serving in... healh care". Planning he Projecs Planning for he parnerships ook several forms which varied among he paricipans: (a) preliminary discussions beween he paricipans and he MSN faculy person, (b) discussions beween he paricipan and one or more ofhe sudens and (c) discussions among he paricipan, faculy person, and sudens. The firs aspec of planning cenered around deermining: (a) wheher sudens would work individually or in groups and (b) wha projecs sudens would do. Paricipans described graduae sudens as having he abiliy o do independen projec-ype aciviies

115 Paricipan B works in an agency wih a wide variey of programs. She observed: "So how can I look wihin my organizaion, my agency or my program o see wha kinds of hings hey may be able o do in somehing ha hey are paricularly ineresed in... because I believe, and his is jus some personal hing, ha if i's somehing ha if he suden is prey passionae abou or ineresed in hen i will be more ineresing for hem, we'll end up wih a beer projec". A leas eigh paricipans noed ha sudens came o he parnership wih prese 106 involving assessmen and analysis of saff or clien needs and implemenaion of an inervenion. There was no clear paern for how opics for projecs were decided. In one or wo cases, he faculy and paricipan deermined wha he projecs would be in advance of suden involvemen. In a few ohers, he faculy andlor communiy parner idenified suggesed projecs and allowed sudens o selec which hey waned o do or acively negoiaed he projecs wih he sudens because hey fel he learning experience would be opimized if he projecs inegraed boh he organizaion's needs and he sudens' ineress. ideas of wha projecs hey waned o do andlor how o implemen hem. Sudens had no considered he needs of he organizaion or characerisics of he cliens. This necessiaed furher suden orienaion o he arge populaion and negoiaion beween he paricipan and he sudens: Paricipan C: "I have an endless lis (of projecs) bu many sudens do come in wih a preconceived noion of wha hey envisioned doing and someimes you have o help hem rehink ha". Paricipan M: "I was very imporan o me ha he sudens realized wha kind ofa populaion hey were working wih because his group wasn' really a exbook or anyhing... and hey sor of had his, 'Well his is wha we are going o go wih his group' which all sounded very, very good bu I said 'You know I really hink ha before you can make any solid plans you really need o come ou and mee his group of people'. This group ofpeople is very unique... and I hough i migh hreaen he success of he projec here so he firs hing I really sor of insised upon was ha hey come ou on a field rip and spend a wo hour session while I was here... "

116 Once he projecs were se, addiional planning concerned he oucomes, imeframe, responsibiliies and oher deails of implemenaion. A number of paricipans commened ha his aspec was oo loose and should have been more highly srucured. Examples of difficulies relaing o planning and implemenaion included: 1. The oucomes and imeframe for he projec were no clearly defined. 2. Sudens changed projecs midsream wihou consuling he paricipan and did no consider he impac his migh have on he paricipan or ohers in he organizaion. 3. Sudens delayed work on he projec and rushed a he end. 4. Sudens did no consider he arge group or seek inpu from he paricipan as hey were working on he projec. Thus, he oucome was no he qualiy ha i migh have been - e.g. a class for fourh graders was augh a a second grade level. 5. Paricipans working wih several groups of sudens found he culminaing evens (i.e. presenaions) were no well coordinaed and srained he schedules of he paricipan and oher saff. 6. Communicaion beween he paricipan and suden was irregular and/or ineffecive. Paricipan K commened on several of hese difficulies: "I know we had a meeing wih (insrucor) and I believe some oher nursing school personnel and we alked abou i and hen I did have a meeing wih like a few sudens who represened he course and we kind of alked abou i and hey would do a (opic) emphasis... In rerospec I hink he planning phase could have been sronger...1hink i's very imporan o address he needs ha arise from he geing o know he person you are providing he service o... I never really me wih he group of sudens who were going o be doing somehing a he school" implemenaion ofhe Projecs Mos suden projecs were designed in so ha sudens would have an opporuniy o do some ype of presenaion (o agency saff or cliens) and leave behind a angible produc ha could be used again in he fuure. In general, sudens implemened he presenaions and 107 hey wen smoohly or bumps were quickly smoohed.

117 Paricipan hough, almos 108 B noed: "They've been of such a high caliber, self moivaed, hey follow hey know wha hey have o do. Yes, here is someimes a challenge because his a piece of a much larger picure so hey've aken he iniial responsibiliy of looking a wha kind ofiming and 1do depend on hem o do ha and like I said, wihou excepion." However, here were insances when he presenaions were less han oally successful. Reasons suggesed by paricipans included: unrealisic goals, lack of horough preparaion, being rushed a he end of he semeser, and difficuly in meshing schedules wih he arge group or projecs changed a he las minue. Paricipan C noed: "I really believe ha ifhe projecs didn' go well probably where we failed was... ha we did no si down and view he deails before implemenaion. So... i was a muual screw up. I didn' push hem o presen o me before hey wen in and hey didn' commi early enough and invesigae wha he (arge group was like)". Communicaion Every paricipan indicaed ha effecive communicaion was a key aspec of he parnerships and some dimension of i (when, how or wih whom) presened a challenge for every paricipan. Paricipan F's organizaion does much of is work hrough commiees working composed of members of he professional communiy and ineresed ciizens. Suden groups wih Paricipan F collaboraed wih several of hese commiees and communicaion wen well: "The sudens self-seleced he projecs hey waned o work on and we le hem know when he commiees were meeing and hey adaped heir schedules o ry o ge o commiee meeings... A he commiee meeings we ry o share wih he chair wha happened... why he commiee was here, wha is goal was, and hen kind of as a commiee work ogeher on he projec ha hey seleced. So hey were working wih he voluneers who were on he commiee and giving inpu o he commiee so ha was very nice." When hey occurred, problems in communicaion concerned paricipan-suden communicaion versus paricipan-faculy communicaion. Reasons proposed by paricipans included:

118 Complex, full schedules ofparicipans and ohers in heir organizaions; 2. Complex, full schedules ofhe MSN sudens; 3. Lack of undersanding or skills of sudens on opimal communicaion wih he arge populaions; 4. The naure ofa paricular suden group; 5. Lack ofa se plan as o how and when o communicae during he period (ofen several weeks) when sudens were working on he projecs off-sie. Paricipans described communicaion as a hread hroughou he parnership. However, i was mos imporan during he ime beween planning and compleion ofhe projecs, when he sudens were no on sie a he paricipans' organizaions. For some paricipans, members ofhe CETSL Advisory Group and (b) four paricipans repored hey have communicaion coninued beyond he individual semeser: (a) seven paricipans have been esablished relaionships wih heir faculy parner ha exend beyond an individual semeser. Two paricipans serve on he Advisory Group and repored an independen relaionship wih elephone, Mehods ofcommunicaion, ranked in order of frequency of use, included: , pager and in-person meeings. Mos paricipans found very useful in communicaing wih faculy and sudens. Two paricipans did no have access o a he faculy member. work bu found sudens and faculy expeced hem o use rouinely. As acual person o person elephone conac was rare, voice mail was found helpful and pagers less so. "We Paricipan J noed: did some ,...hey would page me and I remember his one paricular suden worked in an leu and she would page me and I could call back and leave a message on he voice mail and hen I would be ou ofhe office and she would page me again and I (chuckle) would call her... bu we evenually managed o connec wih each oher..."

119 110 Several paricipans who worked wih muliple groups of sudens noed differences among hem as o efficiency, dynamics, and effeciveness of communicaion. While addressing hese differences complicaed heir role in he parnership, paricipans ended o view such variaions as o be expeced. Paricipan H noed: "(Communicaion wih) he sudens was a lile hard. I hink more han anyhing hey had assigned one person o be he spokesperson bu I hink hey had a few dynamics inernally as in any group orienaion and we couldn' mee alogeher. And alhough we ried o ge everybody o mee a one ime, ha's he problem wih group work. And hen when hey came..hey came wih a shor ime... I mean I'm alking abou his paricular group. I hink i would vary or I know ha ohers have had i easier". Paricipans also saw communicaion wih he faculy as imporan and repored few problems in ha regard. Paricipan's Roles Paricipans played a number of roles wihin heir parnerships. As wih oher aspecs of he parnerships such as communicaion, hese roles increased in number and complexiy muliple layers wihin he organizaion. when paricipans worked wih muliple groups of sudens and when he projecs involved In general order of frequency, paricipans repored he following roles: communicaor, educaor, advisor/coach, liaison, negoiaor, coordinaor, faciliaor, "inermediaor", learner and evaluaor. The role ofcommunicaor was addressed above. All paricipans aced as educaors during he orienaion phase. Some mainained a srong role of educaor and advisor hroughou he projec. However, several paricipans menioned hey did no have close conac as sudens developed heir projec and were no able o guide hem in shaping he inervenion o he unique characerisics ofhe arge group. For some projecs, sudens worked direcly wih he paricipan. In ohers, someimes wih he same paricipan, sudens worked wih oher saff in he organizaion. In hose cases,

120 he oher paricipan played a srong liaison role hrough aciviies such as linking sudens wih III saff, explaining wha he parnership was abou, making sure hey had he buy-in of key personnel and coordinaing schedules. Paricipan G described herselfas having several roles depending on he suden group/projec: "Liaison beween our agency and he sudens and faculy, coach o really ge my saff on board and le hem know ha his is somehing ha hey've asked for... Coached he sudens o help hem undersand ha you're no jus wasing your ime, his is somehing ha we really need and ha I know you have hey skills when hey are quesioning: 'Do I really have he skills o pull his off?. And hen, I hink i almos becomes one ha you are almos a eacher in some aspecs of i, because you are working wih individuals who may no have ever done his before..." A leas four parnerships involved sudens working direcly wih cliens. Those paricipans noed he imporance of gaining he rus ofcliens or inpu from he cliens as o how bes heir needs could be me. Paricipan I has a close relaionship wih her cliens: I " There are key people ha have been here long enough and have wached our ransiion. They're members ofhe communiy, hey sill come and 1 kind of periodically invie hem o a privae lunch and we si down and alk and say 'I'm hinking of saring having somebody who wans o come and do (aciviy), wha do you hink?". Many of he paricipans noed hey were learners wih respec o he parnership process and heir profession. Paricipan A noed: "I hough his was a good learning experience for boh of us because I had never had o do his before eiher...hey gave me a All Oucomes logic model and hen said 'Now hink abou how o do his, give me some examples"'. paricipan who did no repor a successful experience indicaed she remained commied o bu one of he paricipans found he parnership o be a posiive experience. The service-learning and had already applied he lessons she learned in anoher parnership wih grea success.

121 112 Oucomes repored by he paricipans may be divided ino primary and secondary. Primary oucomes were repored by 12 ofhe 13 paricipans and relaed o conribuions made o he work ofhe agency as well as learning by he sudens. The exen o which he primary oucomes were achieved varied. A imes, sudens boh learned and made srong conribuions o he organizaion. Paricipan M noed: "I hink i was a good experience for he sudens. I was a good problem-solving hing, a good eam working hing because hey did divide up he group bu...hey were all doing oher hings and hey needed o cooperae wihin heir own group. (The cliens) would welcome hem back again which is a very high endorsemen from ha group...'could hey come and see us again?'..tha's he highes praise you can ge". In oher cases, suden learning dominaed wih conribuions playing a secondary role. Paricipan C noed ha "I is okay o have i ha way... I hink ha's a par of any cooperaive relaionship is ha here is gonna be cerain hings ha go beer". She gave he example ofa group of sudens who, earlier in he semeser, cancelled a dae o observe a group of school sudens hey would be eaching: "Alhough he sudens in ha classroom probably didn' ge a whole heck ofa lo ou ofhe lesson, he (nursing) sudens learned mega because hey realized his bombed basically, we blew i, in erms ofknowing he developmen. How are we going o change his in weny minues when we go o he nex class?.. And hey, ha's wha eaching is abou, being able o be sponaneous when somehing isn' working. So hey learned a lo:" Secondary oucomes included: 1. Paricipans experienced: (a) Personal, professional growh including learning from faculy and sudens, (b) Opporuniies o fulfill responsibiliies o own profession and alma maer, (c) Professional relaionships wih he faculy members. 2. MSN sudens learned abou he agency and is services. 3. School sudens saw MSN sudens as role models.

122 The communiy organizaions received funding for he projec Projecs compleed by he sudens could be used again in he fuure. Paricipans hoped he MSN suden would work for he organizaion in he fuure. Scope ofhe Parnerships The scope of he parnerships may be viewed in erms of he number of courses, faculy, semesers, and sudens he paricipan had worked wih as well as he number of projecs done (many sudens worked in groups). Gahering his informaion was a challenge. A number of he paricipans were no cerain of his informaion (especially number of sudens and projecs), so he researcher aemped o rerieve i from CETSL projec records. As indicaed in Table 7, he scope of paricipan's relaionships wih MSN servicelearning aciviies during he wo and one-half years since he projec began varied widely. However, some rends can be derived. Nine parners had worked wih one faculy person for one (seven) or wo (wo) semesers. All expressed a willingness o coninue involvemen in service-learning bu several had no worked wih he course when i was augh again following he service-learning semeser. In wo cases, a second opporuniy for servicelearning had no ye occurred (i.e. parnered in a fall semeser, inerviewed in he following spring semeser). In hree cases, paricipans had worked wih one course and one faculy person for wo or more semesers. All expressed saisfacion wih he parnership. Two indicaed hey planned o coninue he parnership again and one indicaed a possible ineres in coninuing. The wo remaining paricipans had, for various reasons, worked wih muliple courses and faculy, each for one semeser. They boh indicaed a srong commimen o service-learning, bu expressed a desire o work wih one faculy member in a coninuing relaionship.

123 114 As he focus of his sudy was process raher han oucomes, he researcher did no aemp o mine informaion concerning he oal number of sudens and projecs. However, Some ranged from 1 suden o I small group of sudens o up o 6 sudens or groups of sudens. paricipans repored he number of sudens hey had worked wih during one semeser suden who eiher required or recommended a srucured relaionship (e.g. wrien plan wih specified oucomes, responsibiliies and imeline and/or a designaed spokesperson for each group) were hose who had worked wih several groups of sudens during one semeser. Differences Beween Graduae and Undergraduae Sudens The issue of differences beween graduae and undergraduae sudens firs arose in he inerview wih Paricipan C. She had noed he influence ofmsn sudens' busy schedules on he qualiy of a paricular projec: "Many of he sudens in he program have complicaed work schedules and work commimens and family commimens and you're never gonna please everybody... We had one projec ha here were wo hemes. The one heme was eaching nuriion bu he oher, wha I hough was more imporan was ha i was a eaching projec ha was going o be implemened in wo very culurally differen buildings. As a resul of hem... procrasinaing he one building go knocked ou and we could no do i so i sor ofdefeaed he purpose ofhe projec... " In ligh of his remark, he paricipan was asked abou he differences beween MSN and undergraduae sudens. "I hink here is a huge difference...i hink MSN sudens are more comforable wih...heir nursing pracice and...heir comfor level is differen in ha hey have confidence in heir nursing skills and jus heir pracice in general whereas 1hink BSN sudens are sill formulaing heir comfor level. Also, I hink MSN sudens have life experiences and professional experiences o draw upon...1 hink hey relaed beer o he parens... Is like a hose dolls ha fi ino one anoher, jus anoher layer o use". paricipans oversaw up o six projecs in one semeser. I was noed ha paricipans

124 115 Following his observaion made by Paricipan C, he researcher added a quesion o "graduae he inerview guide ha asked if paricipans had worked wih undergraduae sudens in he pas and, ifso, o compare/conras heir experiences in working wih MSN sudens versus undergraduae sudens (of any discipline). Six ofhe eigh paricipans inerviewed afer Paricipan E shared heir houghs on he differences and similariies in MSN and undergraduae sudens. When noed, ypes ofundergraduae sudens ha paricipans had worked wih included: nursing, educaion, liberal ars and AmeriCORPS. One paricipan had exensive experience wih associae degree nursing sudens. Some paricipans had worked wih oher ypes of graduae sudens (e.g. social work) and responded o he quesion as sudens" raher han MSN sudens. Paricipans described clear differences beween undergraduae and he MSN sudens. Lised below are poins raised by more han one paricipan wih he mos frequen and characerisics poins lised firs. The poins are followed by discussion of wo discrepancies in paricipan feedback and relevan quoes. An imporan noe is ha several paricipans observed variaions among individual sudens and suden groups as o hese characerisics. 1. MSN sudens have busier, more complex lives wih demands relaed o school, work family. Sudens' were no able o be flexible ime-wise. Their availabiliy for a horough orienaion o he communiy organizaion and o mainain close, regular communicaion wih he communiy conac person was limied. In some cases, his led o less han opimal oucomes as sudens' projecs were no geared o he (e.g. ime availabiliy, socio-culural or developmenal rais) ofhe arge populaion. 2. MSN sudens bring a higher level of knowledge. Several paricipans noed ha hey gained new informaion from he MSN sudens.

125 MSN have more exensive professional and life experiences on which o draw. 4. MSN sudens are more comforable in heir pracice. 5. MSN sudens are free and open in discussion, more ap o raise quesions. 6. MSN sudens inerac a a higher level and are more analyical. In some cases, when he paricipans firs me he MSN sudens, he sudens were no fully commied o he idea ofa service-learning projec. Paricipans suggesed his migh be due o ime limiaions or no seeing he learning value ofhe aciviy. Paricipans gave conflicing responses regarding wo characerisics of MSN sudens: he need for supervision and ineres in learning. In erms ofheir overall aenion o he projecs, several paricipans noed ha sudens were less self-direced and needed more supervision or direcion han he communiy parner had expeced. This was aribued o heir busy, complex lives. One paricipan who worked wih boh MSN and ADN sudens in a direc clien care siuaion found he MSN sudens, as licensed regisered nurses, required less direc supervision. In describing sudens' openness o learning, a leas wo paricipans used he erm "sponge". However, he erm was used for boh undergraduae and MSN sudens. Several paricipans described MSN sudens as being more focused on heir educaion and ineresed in learning han undergraduae sudens. However, hey noed ha his ineres was raher AmeriCORPS narrow and geared o heir specialy area of nursing. One paricipan found he Universiy's sudens (voluneers for communiy service) o be more open o learning and flexible in scheduling o mee agency/clien needs. Several quoes illusrae he differences ha paricipans observed beween MSN and undergraduae sudens and he differences beween individual paricipans' experiences. Alhough facors influencing parnerships are discussed in he nex secion, recommendaions

126 117 I Service, ha paricipans made concerning working wih MSN sudens have been included here. Paricipan 0 noed: "I find...hey are much more analyical and hey will come back wih many more quesions as o 'Why do you do his?' or 'I don' know ha I could do his'. I mean hey're much freer wih heir commens. I hink hey feel much more confiden wih hemselves, which is good...he grad sudens...are like a sponge...hey wan o absorb everyhing hey possibly can... Paricipan G noed: "I find once hey hi grad school hey... have a mind of heir own and hey have heir prioriies and hey've been in he work world for a while. So here are hings hey are no going o do. So you have o help hem o become sponges and wan i. So you always have o be creaive in he way you presen i Whereas wih undergrads (referring o AmeriCORPS sudens), hey are comin' in awe like wow and hey're like sponges...hey are flexible and hey are willing o ake on more. They're no saying 'How is i gonna fi in my life?'.they are like 'Oh, how can I fi my life around his righ now". Paricipan E noed: "I hink mos people are no accusom(ed) o having graduae sudens ou in he field so... i could be a new experience for some people. Bu for agencies ha I know abou i's always been a good experience. I hink if you are a person who works wih sudens, hen you know wha o expec. I mean you know ha you can come and only do so much, and wihin hese ramificaions and you know your bachelor's level people can do his and your graduae level people can do a wee bi more". Paricipan H observed: "...graduae sudens end o be working full ime and going o school so heir ime is a lo more limied. I also hink ha since hey're working hey have a endency of focusing more on heir specialy where hey're working. So o work in he communiy...hey're no really sure abou i, where does i fi in heir plans and I hink undergraduae sudens jus ake i as par ofheir curriculum. They haven' goen so...focused on where hey are going. Personally, I hink i's imporan hey ge a broader view, and how if you are in he communiy wha he needs are and how ha would fi in wih heir work... CETSL Advisory Group The MSN Program's service-learning projec included he Communiy Engagemen Through Service-Learning (CETSL) Advisory Group composed of represenaives of communiy organizaions, faculy, CWRU safffrom he Office of Suden Communiy and sudens. A core group of members aended from he sar of he projec.

127 courses I a I 118 However, each semeser, faculy and communiy parners involved wih service-learning were invied o join he group. As he firs paricipan in he sudy commened on he key role he CETSL Advisory Group had played in her work wih he MSN program, a quesion was added o he inerview guide. Six of he 13 sudy paricipans aended CETSL Advisory Group meeings as ofen as possible. Four were founding members of he group and five aended a service-learning insiue sponsored by he MSN program. One oher paricipan noed she would have liked o be a member of he group, bu given consrains on her ime, fel i was more imporan o work wih he sudens. She did send a represenaive o a CETSL recogniion even and i was a ha ime ha she became aware of he wider scope of he service-learning projec beyond he specific faculy member wih whom she had parnered. All six members of he Advisory Group found i o be an imporan aciviy and recommended i for oher communiy parners. One paricipan fel regular aendance should be required for all acive parners. Advanages of aending he Advisory Group included: 1. Paricipans gained knowledge abou he profession of nursing and is curren direcions, service-learning, he MSN program, and aciviies of oher member parners. 2. Paricipans had opporuniies o nework. Several paricipans made linkages wih oher communiy agencies ha hey subsequenly used in heir pracice. 3. Paricipans enhanced heir parnership. They had opporuniies o mee wih heir faculy parner and gained ideas for fuure suden projecs Pluses included: (a) he iming of he meeings; (b) benefis such as samping for parking and providing lunch; (c) reminders, (d) copies of minues a he meeings and via , and (e) efficien conducing of he meeings by he chair.

128 119 I and Several members of he CETSL Advisory Group poined o a parnership involving anoher paricipan member of he group as an example of he ype of parnership hey would like o achieve. They noed his individual had an advanage as she had worked wih he same faculy member and he same course for hree years (one semeser per year) and hey had developed a close working relaionship. Research Quesion 2: Wha facors do communiy organizaions idenify as influencing parnership wih a graduae nursing educaion program? Paricipans described seven key facors as influencing he success of parnerships wih he MSN program and offered recommendaions as o how o address hem. Alhough facors were idenified hroughou he Level II codes, hey were elicied largely from five codes: facors influencing parnerships, lessons learned, posiives, problems/challenges and recommendaions. The facors idenified as influencing he parnerships are lised in Table 6 o add clariy o he facors. Some address more han one facor. discussed below along wih heir relaed recommendaions. Relevan quoes are included Commimen Commimen by all involved in he parnership was seen as a key facor in he success of he relaionship. There was consensus ha iniial commimen should be beween he communiy conac person (CCP) and he faculy person. However, sudens were also seen as inegral members of he parnership and should be oriened o, and acceping of, he service-learning aciviy before meeing wih he communiy parner. Paricipans indicaed ha alhough he iniial link occurs beween wo individuals, success of he parnership is faciliaed by suppor from he communiy organizaion iself and ha, over ime, commimen should lead o a close working relaionship beween he faculy member and he CCP characerized by flexibiliy, respec and rus.

129 120 Table 6 Facors Influencing he Parnerships Facor Communicaion Commimen Descripion There is regular, effecive communicaion among all parners. All involved suppor and commi o service-learning and he I Orienaion Shared goal Planning Reciprociy Evaluaion parnership. There is a close working relaionship beween he parners characerized by flexibiliy, respec and rus. Each parner is familiar wih he ohers' organizaion, needs, resources and culure (of arge populaion and MSN sudens) Parners discuss heir expecaions and objecives; develop shared goal based on communiy service needs and suden learning needs. A realisic plan is muually developed and wrien wih specific oucomes, imeline and responsibiliies. The plan is adhered o and changes made only wih agreemen of all parners. All parners should experience posiive oucomes. The communiy parner is viewed as a resource and eacher. Parners should deermine effeciveness ofparnership & o improve he parnership (inpu form all sakeholders, planned in advance). I Paricipans recommended sraegies o achieve reciprociy: (a) ongoing relaionship wih one insrucor, (b) good communicaion beween he CCP and faculy member and (3) suppor by boh insiuions as weli as he individual faculy and CCP. Paricipan B saed: "I hink he hing is ha you have o be commied o i... You have o... If I was no... so passionae abou i and ha I didn' believe in wha i was... i migh be differen. Bu I've made i a prioriy because I hink i is worhwhile... no only for he suden bu wha he oucomes will be and so I hink ha everybody's been very flexible". Paricipan G noed: "I hink working wih one person does give you a chance o faciliae he process and work ou any quirks and use i he nex ime in he proper

130 121 way... I I I Because he needs ofhe classes and needs ofhe agency are consanly changing ha he closer ied ino he needs of boh...he beer i would be... I know ha when I lisen o (anoher communiy parner) and wha hey have accomplished ou here and ha's been he whole ime of being par of i, i keeps growing because hey are consanly evaluaing, consanly changing, consanly communicaing ha every suden who goes ou here ges a differen experience and i's a posiive experience. Communicaion I I I I presenaions I Paricipans viewed communicaion as he mos imporan facor in he parnerships and as a hread hroughou all sages of he parnership process. Aciviies such as preliminary discussions, orienaion, wrien plans and evaluaion were all aspecs of communicaion. Communicaion should be regular and effecive and he mehods of communicaion agreed upon in advance by all parners. Possible mehods of communicaion included: , elephone, pager, mail, and in person meeings. I was suggesed ha sudens send a weekly updae o he CCP and faculy person regardless of wheher acion had occurred. Paricipans srongly recommended ha sudens allow ime o review heir projecs wih he CCP and do a dry-run of any before he scheduled dae of implemenaion. Orienaion Paricipan E saw communicaion as he mos imporan facor in he parnership: "Ge he phone numbers where people can be reached, ge addresses and alk o hem. I mean I never fel ou of conac o anyhing... I knew your name, I had your phone number... As long as I can conac he people I'm working wih, I'm okay... " Paricipan 0 noed: "...Lisening and really hearing i and being able o keep he communicaion lines open...to me ha's key...if you can do ha...almos anyhing can happen..." Paricipans were in clear agreemen ha orienaion ofall parners is an imporan facor in promoing he success of he relaionship and he suden's projecs in paricular. I

131 122 Orienaion occurs in hree phases. Firs, he faculy member and communiy conac person familiarize each oher wih heir organizaions, resources, and needs. If he individuals decide here is a service-learning fi, hen more in-deph orienaion occurs as o he srucure of he organizaions. A key componen is an undersanding of each oher's culure. The faculy member should undersand he culure of he organizaion and he likely arge group educaional insiuion and of MSN sudens (i.e. how hey differ from undergraduae sudens in erms of heir srenghs and consrains). The parners begin o explore suden projecs. The hird phase oforienaion involves he sudens. Suden orienaion should be a (i.e. saff and/or cliens). The communiy parner should undersand he culure ofhe a Sudens eam effor by he CCP and faculy member. The CCP may visi he school o inform sudens abou he organizaion and discuss possible projecs. However, all sudens should ake ime o visi he communiy sie and observe services/cliens. The orienaion o he communiy parner should be sufficienly horough ha sudens undersand where heir projecs will fi ino he broader work of he organizaion and he culure of he organizaion and is cliens. I credibiliy wih and accepance by he arge group. Paricipan F commened on he challenge ofhe sudens' busy schedules versus her beliefha orienaion o he organizaion is helpful: "..I migh have been nice o have been able o have hem come o some of our oher commiee meeings or...o ge... a lile more insigh ino our srucure bu I'm no sure, ifha's feasible really...because hey were prey much focused on heir projec, if hey did ge he full flavor of he whole organizaion...if ime would have alloed...1 would have goen hem ino some oher...experiences wih he organizaion...bu I hink ha was prey limied and hey had ouside work ha hey had o do on he projecs..." Paricipan M noed: "I really hink ha he key is o know your populaion, know heir srenghs, heir weaknesses and wha hey need. And hen I hink you have o...aim your program a wha's specific for ha group wheher is eenagers,..., baby boomers, seniors... and hen you need o know a lile bi abou heir demographics...you need o know if here's money o be spen on i...and wha may need o do special learning abou he arge populaion i.e. from he socioculural or developmenal perspecives. Visibiliy ofhe sudens may also faciliae

132 123 expers you can call upon... and hen you have o fi ha all in o whaever.. he school... or sudens are looking for his experience...he firs hing is you have o know your populaion" I Shared Goal The faculy person and he CCP should discuss heir expecaions of and objecives for he parnership. Objecives should include boh meeing communiy idenified needs and suden learning objecives. A he coordinaion level, each parner may have an independen I I I I I I I I a I I I goal ha can be me hrough he relaionship. As he relaionship moves oward collaboraion and parnership, he goal becomes a shared one hrough which communiy idenified needs and suden learning objecives will be me and goals are se for he parnership iself. Planning Paricipan J noed she learned from previous experiences wih parnerships ha "... everyone should be on he same page abou wha was o be expeced and wha was o be done... keeping in mind ha each...eniy has is own goals and objecives bu ulimaely you know is imporan ha hose be shared...and ha here be a common ground and if here were problems or challenges ha hey be discussed and you know ry o remedy..." The firs par of planning involves final decisions as o he sudens' aciviies. The overall goal mus be o mee communiy-idenified needs. Paricipans found ha he unique knowledge and skills of MSN sudens were opimized when heir aciviies lef some angible projec ha could be used again in he fuure. Paricipans noed ha sudens' saisfacion was highes when hey were able o complee a disinc projec and had he opporuniy o presen i o or share i wih he arge group. A imes, communiy needs were such ha i was difficul for projecs o be complee in he course of one semeser. Paricipans suggesed ha he faculy and CCP sraegize ways o mee suden needs for closure and communiy needs for complex projecs. The CCP and faculy may predeermine he projecs and assign hem o he sudens. However, sudens are more likely o buy ino he projecs if hey have some say in wha hey

133 I I 124 will do. CCPs may wish o consider he sudens' personal ineress and unique skills (such as language) in deermining wha projecs will be done. The CCP may also need o negoiae he projecs if sudens come wih pre se ideas. Once he projecs are se, he faculy person, CCP and suden work ogeher o develop a plan of implemenaion. Paricipans agreed ha he plan be wrien wih specific oucomes, responsibiliies, and imeline. One paricipan developed a form for his purpose. The plan should be prepared and implemened as early in he semeser as possible. Changes should be made only if absoluely necessary and should be agreed upon by all parners. The involving I I mos successful projecs were hose where sudens were well organized, sared work on heir projecs promply, and adhered o he plan. Recommendaions relaed o planning (in order offrequency of menion) included: (a) seek funding o suppor he parnership, (b) consider spring semeser for aciviies school nurses as hey are very busy in he fall semeser, (c) have a back-up saff member in case he CCP is unable o follow-hrough, (d) have an overall heme for he semeser, especially ifhere are several groups of sudens, (e) provide communiy parners wih a one-page overview of service-learning and a lis of previous projecs done. These can hen be shown o oher agency saff when he CCP is seeking heir suppor and inpu or he parnership. Paricipan H saed: "One of he big hings is good communicaion abou wha your plans are, wha your goals and objecives are and your ime line.. Try o see ifhere is some way a leas one ime ha all paries can mee ogeher near he beginning...ha would be so helpful even if i's only for hiry minues all a one ime..." Paricipan C found a wrien plan o be a necessary o success of he parnership: "I hink he proposal shee, if you can ge hem o commi and hey can' really change heir mind afer he proposal shee is submied ha would help... ifhey changed heir mind and I had already se up an implemenaion dae hen ha had o be changed no only wih he adminisraor bu wih he eacher and so i is... very, very complicaed..."

134 I Reciprociy Paricipans described he opimal parnership as being dynamic bu seeking reciprociy, ha is, relaive equaliy in conribuion of resources, effor and oucomes. This process requires a long-erm commimen o he relaionship -beyond one semeser. Lessons learned and evaluaion findings are used no jus o improve suden aciviies bu o shape he parnership iself. As noed previously, paricipans who were members of he CETSL Advisory Group were hose who had worked wih MSN sudens for more han one semeser and saw i as a valuable aspec of he parnership. Evaluaion Paricipan K ariculaed wha i akes o have a reciprocal relaionship: "clariy of wha your purposes (are)...wha is he benefi o each of he parnering organizaions, wha'll each of us hope o ge ou of his, wha are each of us conribuing o i, we were very very explici abou ha...ime o plan...you really need o have conversaions in order o come o hose...ha clariy...ongoing dialogue wih a grea deal of flexibiliy because hings will never go exacly as you hough and if you use ha o conclude okay well his isn' going o work les forge i...ha would be a loss... Bu if i's a rue service learning, he learning is as imporan as he service so he organizaions are also learning wha i akes o be collaboraive organizaions". Paricipan C described how she and her (faculy) parner were making plans o improve he parnership iself: "... We're gonna ry o do each year... in he fuure...a heme for he year and hen direc he sudens ha way...(my parner) and I ge back and kind of recap... and we basically know wo areas ha we need o work on are he orienaion piece... and we did alk abou communicaion. The oher las hing... is for some of he projec we will ask for (saff) feedback... developing some jus brief checklis..." A few paricipans fel very srongly ha evaluaion should be a key componen of he parnership. They indicaed ha evaluaion is he only means by which parners can: (a) deermine wheher he goals and oucomes had been achieved and (b) idenify sraegies o 125 improve he parnership in he fuure. I was recommended ha evaluaion involve inpu from ~ I all sakeholders and be planned in advance.

135 126 I I When paricipans who did no menion evaluaion as a key aspec ofhe parnership were asked abou i, all agreed ha i should be incorporaed ino he imeline for he semeser. Several noed ha he final aspecs of sudens' projecs were ofen rushed a he end of he semeser and here was no ime o underake a formal evaluaion. Some paricipans did sae hey followed-up wih he faculy a a laer ime. Paricipan K noed: "Evaluaion is exremely imporan... you know any ime you are uilizing ime and resources you need o make sure ha maybe... wha you're geing ou of i is differen han wha you hough you hough you were going o ge of i or wha you inended bu you do need o make sure ha hose ime and resources have been well spen... I jus hink every sakeholder has o really sep back and look a wha were he oucomes wha was he process and do ha evaluaion. Now ha can be very qualiaive. I don' hink i has o be a collecing numbers ype of hing... on he oher hand, you could do ha as well". Resuls oflevel III Coding of 8 ~ Phase II of he daa analysis cenered around furher refinemen and synhesis of he Techniques used during Level III coding included soring he caegories ino he six C coding families and as well as coninued consan comparison and memoing. The purpose Level III coding was o refine he emerging caegories and heir properies ino a more ighly organized and synhesized se ofcodes. Table 7 liss he Level III codes. Level III coding allowed he researcher o concepualize he caegories as a process which was furher refined and described as he BSP during Phase II of daa analysis. Key facors seen as influencing he relaionship were inegraed ino he sages of he BSP. Phase II: De-limiing he Theory involved hree aciviies: 1) idenificaion of he BSP and six relaed conceps along wih heir caegories along wih he labeling/descripion of he BSP (basic social process). Phase II I key caegories, properies, and ineracions; 2) member checking ofhe resuls and 3) furher synhesis of he resuls o idenify core consrucs of he emerging, descripive heory.

136 Table 7 Level III Codes 127 I I ~. I I a Code Theme Conex Characerisics/naure of he: Paricipans, organizaion, faculy,graduae sudens Cause Reasons for engaging in he parnership, Goal of parnership Coningencies Pre-meeing by faculy & paricipan, Undersand each ohers' organizaions: mission, goals, resources, needs, ec, Agree o work ogeher Preliminary planning Possible projecs - based on agency needs & suden learning objecives Ideal: funding suppor Co-variances No used in his sudy (per Huchinson, 1993) Condiions Orienaion of sudens, Muual rus, respec, Clearly, defined plan - proposed oucomes, agreed upon by all, wrien, Specific imeline -sick o imeline Communicaion - among all sakeholders, regular, Plan evaluaion, celebraion Consequences Oucomes for communiy organizaion, Paricipan, Sudens Cooperaion versus collaboraion versus parnership Member Checking I was during he period of Phase II analysis ha paricipans were invied o he group meeing. As discussed in Chaper III, five of he 13 paricipans aended. Paricipans received a copy of he resuls a ha poin and heard a brief oral presenaion of he resuls by he researcher. Those presen affirmed he findings and offered no addiions or deleions. The paricipans did noe he imporance of orienaion of sudens o he communiy organizaion and of effecive communicaion hroughou he semeser. A he reques of he funder, paricipans were asked o commen on he exen o which hey were involved in, and heir houghs on, evaluaion and reflecion. As noed in he sudy, paricipans saed hey believed

137 none I 128 evaluaion ofhe parnership was very imporan bu ha heir acual involvemen in i had been minimal. As for reflecion, several were no aware of is key role in service-learning and had been involved in i wih he MSN sudens. All agreed hey would have liked o play a role in evaluaion and reflecion as well as celebraion. Following he group meeing and furher refinemen ofhe resuls, he second round of wrien member checking was conduced. A summary of he resuls (Appendix G) was mailed o he 12 remaining paricipans along wih a selfaddressed, samped envelope and a reques o a commen on he summary and reurn i. Noe: he hireenh paricipan had Seven noified he researcher she was no longer wih her agency and had no offered a new address. ofhe 12 paricipans reurned he final summary. An eighh paricipan reurned heir individual summary wih commens and included he samped reurn envelope for he final summary. She did no include or commen on he final summary. All seven paricipans who reurned he final summary noed agreemen; here were no addiions or correcions. Commens wrien by he paricipans are as follows: "Agree"; "Good summary"; "Agree enirely"; "I agree wih his summary"; "Excellen, very beauiful"; "Very good (nex o CONNECT), Good luck!"; and "I cerainly agree wih your sudy ofhe need o "Teaming Up! I has opened many new venues for nursing sudens o learn and for communiy agencies o parner wih fuure nurses. I has also provided professionals o assis in eaching/shaping he upcoming nurses. Orienaion o he agencies is a mus and offering sudens and effecive working relaionship wih each mus be sressed. Sudens mus feel a par ofhe organizaion and no jus do a "roe" job. The fuure will open many doors. I hope ha (agency) can coninue o be a parner".

138 129 BSP: Connecing/or Parnership leading I Glaser and Srauss (1967) described he overall goal of grounded heory research as o idenificaion of a "Basic Social Psychological Process" or BSP. Srauss (1978) described he BSP as having four characerisics: 1) recurs frequenly in he daa, 2) links he various daa ogeher, 3) explains much of he variaion of he daa and 4) has implicaions for a more general or formal heory. As he purpose ofhis sudy was o examine he process involved in he parnerships beween he paricipans and he MSN program, he researcher was no surprised o find ha early daa analysis led o caegories which refleced a sequence of seps in he process. Subsequen analysis idenified he naure of, and influencing facors, for each sep. a The second level ofhe parnership is "susaining", in which he CPP and faculy person commi o a coninued working relaionship. The wo levels are discussed in deph in he secions on "Delimiing he Theory" and "Wriing he Theory". Conceps: Once he BSP has been idenified, he focus ofgrounded heory daa analysis becomes idenificaion ofhe relaed conceps. Thus, he weny Level II caegories and five Level III caegories were analyzed furher and synhesized ino six conceps along wih heir properies. In his sudy, he conceps, discussed below, are also he sages ofhe process. Furher analysis and examinaion ofhe daa revealed wo levels of parnership among he paricipans: a shor erm, one semeser level and a longer erm level. Afer much consideraion of a number of relevan erms such as link and unie, he erm "eaming" was idenified as he mos appropriae descripor ofhe iniial level of parnership.

139 I 130 During Ready o commi? "Ready o commi", he sage is se for iniiaion ofhe parnership. Two key characerisics ofhe faculy and communiy conac persons (CCP) are key o fuure success ofhe "connecion": (a) cerain characerisics ofhe faculy and CCP will faciliae developmen ofa working relaionship and (b) commimen by all paries is essenial o long- erm success of he parnership. Commimen of sudens o heir aciviies is also necessary for shor-erm success during a specific semeser. The CCP should be secure in his/her posiion and have a broad undersanding of he organizaion, is mission, srucure, cliens and saff. The CCP builds on previous experiences in parnerships and working wih sudens. The communiy organizaion should be relaively sable and suppor parnerships and educaion. Faculy should value service learning and parnerships as a way o achieve learning objecives and have augh he course Geing o know you in he pas before inegraing service-learning and CCPs for he firs ime. faculy persons acually "connec" and begin o lay he groundwork for he parnership. The "Geing o know you" sage is he period when he communiy conac and ~ Collaboraive pre-planning by he faculy person and he CCP should precede "connecion" wih he sudens and should include: (a) sufficien familiariy wih each oher o deermine if here is a service-learning mach, (b) in-deph orienaion of each oher as described earlier focusing on he needs and culure of he CCP's arge populaion and he learning needs and he MSN sudens, (c) defining a muual service-learning goal, and (d) early planning of suden aciviies and evaluaion.

140 131 Suden orienaion o communiy organizaion Once he faculy person and CCP have begun o develop a working relaionship and preliminary planning for he parnership, he "connecion" exends o include he sudens. Early conac wih sudens should involve a wo-phase orienaion: (a) "academic" orienaion o he course and he service-learning projec and (b) orienaion o he communiy organizaion. Orienaion of sudens o he communiy organizaion should be a eam effor by he faculy and CCP. Sudens should undersand he agency's mission, services, srucure, resources and needs as well as he culure of he populaion served. The CCP may visi he school bu sudens should visi he agency sie and observe/paricipae in service provision. Thorough suden orienaion, especially o he communiy organizaion, is a key facor in I I promoing success of service-learning and he sudens' projecs in he shor run and, in he long run, he parnership iself. We're underway During he "We're underway" sage, he specific plan/s for ha semeser's "connecion" is/are developed. A he end of orienaion or early in he implemenaion phase, he faculy, CCP and sudens should make final decisions as o he projecs o be done. Inegraing suden ineress and skills will faciliae heir buy-in bu ulimaely, meeing agency needs is he prioriy. A specific, wrien plan is developed wih realisic objecives, defined responsibiliies and clear imeline. All paries should sign off on he plan. Three facors are key o successful implemenaion of he plan: (a) being flexible while adhering o he plan and making changes only wih agreemen of all parners, (b) effecive, regular communicaion and (c) he CCP's roles such as: liaison, educaor, negoiaor, coordinaor, direc supervisor and learner are geared o he specific siuaion.

141 132 We did i! The process of"connecion" should coninue pas he compleion of he sudens' projecs. Follow-up is imporan o closure ofhe semeser for he sudens and helps promoe coninuaion ofhe relaionship beween he faculy and CCPs. Follow-up aciviies should: be given prioriy; se in advance as par ofhe iniial plan; involve all sakeholders; and include evaluaion, celebraion and reflecion. Looking ahead Communiy-academic parnerships have heir "bumps in he road" and ake ime o develop and evolve. A one-semeser relaionship may have posiive, oucomes for a specific suden projec or projecs. However, a long erm relaionship beween one CCP and one faculy member ses he sage for a "connecion" ha can evolve ino a rue parnership wih oucomes a a higher level. When he faculy person and he CCP are commied o he "connecion: and coninue i ino fuure semesers, hey can use lessons learned and evaluaion resuls o improve he relaionship and move oward a higher-level parnership. The parners idenify muual goals for enhancing he parnership iself as well as for specific suden projecs. Paricipaion in he CETSL Advisory Group is anoher dimension ofcommimen and has several poenial benefis for he CCP including: (a) becoming par ofhe broader MSN service-learning projec, (b) involvemen in planning and decision-making for he MSN projec, (c) mainaining a working relaionship wih he faculy person ouside ofhe regular semeser, (d) opporuniies o nework and learn wha oher parnerships are doing and (e) promoing personal and professional growh.

142 133 Core Consrucs The hird phase of Phase II of he daa analysis involved idenificaion of wo core consrucs of he emerging, subsanive heory: Teaming and Susaining. These consrucs reflec he realizaion ha paricipans fell ino wo broad groups according o he exen o which hey had engaged in parnership wih he MSN program. Boh groups repored posiive oucomes; however, he naure ofhe relaionship differed being more complex a he second, or susained, level. Table 8 depics he flow of daa analysis from Level II caegories, o Level III conceps and consrucs. Three caegories, communicaion, planning and evaluaion, are lised more han once as hey have uiliy for more han one concep. Teaming Seven of he 13 paricipans had worked wih a MSN faculy person and sudens for one semeser. Six repored posiive oucomes and saisfacion wih he relaionship and hree hoped o work wih MSN sudens again. Two oher paricipans had eamed wih MSN sudens for more han one semeser and were commied o a service- learning relaionship bu had been symied by having worked wih differen faculy each semeser. One oher paricipan worked wih one faculy (bu wo courses) for wo semesers bu had no coninued he relaionship furher. These en paricipans referred o heir relaionships as "parnerships". However, hey were acually bes described "eaming"; goals and oucomes were limied o discree suden projecs. Reasons for a one-semeser relaionship beween a paricular CCP and faculy member were no sough ou in his sudy. Two paricipans had jus parnered for he firs ime during he semeser in which he inerviews occurred; however, he ohers had parnered 6-18 monhs before he inerviews and had no parnered wih ha faculy member again.

143 134 Table 8 Connecing for Parnership: Core Consrucs, Conceps and Caegory Core Consruc Concep Caegory Teaming Ready o commi? 1. Paricipans & heir organizaions 2. Iniiaion 3. Prior parnerships Geing o know you Suden orienaion o communiy organizaion We're underway We did i! 4. Orienaion of parners 5. Naure ofmsn sudens 6. Purposes -expecaionsgoals 7. Planning 11. Communicaion 8. Orienaion of sudens 7. Planning 9. Implemenaion 10. Roles 11. Communicaion 12. Evaluaion 13. Lessons learned 14. Follow-up 15. Oucomes 16. Posiives 17. Problems/Challenges Susaining Looking ahead 19.Recommendaions 20. Advisory group 11. Communicaion 7. Planning 12. Evaluaion Susaining Two ofhe 13 faculy-ccp relaionships had achieved he level ofcollaboraionparnership and had demonsraed a commimen o susaining he parnerships. One oher appeared o be moving in ha direcion. These siuaions were ones in which he faculy and CCP had worked ogeher for a leas wo semesers. They verbalized a commimen o

144 135 I relaionships ouside of he service-learning semeser iself (e.g. working on oher projecs or coninued parnership and were seing goals for he parnership iself and/or had professional I I membership on he CETSL Advisory Group). Phase lil Wriing he Theory In he grounded heory approach o qualiaive research, he hird phase of daa analysis is wriing of a subsanive heory. During his phase, he researcher begins o ransiion from he resuls of daa analysis o he findings of inerpreaion. In keeping wih he grounded heory radiion, he researcher will briefly describe he proposed heory as par ofhis chaper in order o demonsrae he "grounding" ofhe heory in he daa. The proposed heory will be furher explored in erms ofconclusions as compared o relaed lieraure, implicaions, and limiaions in Chaper V. Connecing for Parnership: A Descripive Theory ofcommuniy Organizaions'Relaionships Wih A Graduae Nursing Program Parnerships beween communiy organizaions and a graduae nursing program can be an effecive means by which MSN sudens receive communiy-based service-learning experiences communiy-idenified needs are me. The parnerships begin wih level one, Teaming Up, and mayor may no ransiion o level wo, Susaining. Each level of parnership is influenced by cerain key facors; some facors are common o boh levels (i.e. planning, communicaion and evaluaion). Teaming The process of Teaming involves a relaionship in which an MSN faculy and communiy conac person (CCP) commi o working ogeher for a leas one semeser. To be successful he parnership process proceeds hrough a series of sequenial seps (Table VII) during which he parners: (a) decide o commi o he relaionship, (b) develop a working

145 136 relaionship, (c) idenify muual goals, (d) orien he sudens o he communiy organizaion and is culure, and (e) plan, implemen and evaluae he parnership. Primary oucomes relae o he immediae conribuions made o he work of he communiy The "eaming" level of parnership may lead o primary and secondary oucomes. organizaion by compleion of he specific projecs as well as learning experienced by he MSN sudens. Secondary oucomes include oher benefis o he paricipans, heir organizaions, MSN sudens, and agency cliens. Key facors influencing success ofhis phase include: (a) regular, effecive communicaion among all parners ha is carried hrough o evaluaion and celebraion; (b) muual rus and respec; (c) he degree of commimen by each parner; (d) each parner's he exen o which faculy, sudens and CPP are acive and equal parners in a relaionship of undersanding ofhe oher's organizaion and culure, specifically he CPP's arge populaion and he naure ofmsn sudens; (e) realisic goals which can be me hrough he parnership during he semeser; and (f) a wrien, clear plan wih defined oucomes, responsibiliies and imeline. During a one-semeser relaionship, i is possible for all parners o achieve boh primary and secondary oucomes albei shor-erm and limied in scope. A his ime, he may ransiion o he second level, Susaining. One case was observed in which he relaionship beween he wo founding parners (generally he faculy and CPP) may end or i follows are no clear from his sudy. parnership was beween a suden and CPP. Facors influencing which pah he parnership Susaining Faculy and CPP who have engaged a he "Teaming" level may coninue heir commimen beyond he iniial semeser and work ogeher again during fuure semesers.

146 137 The working relaionship involves coninued collaboraion wihin he framework described above. This may occur in sequenial semesers or on an annual basis (i.e. one semeser a year). A key facor influencing "Susaining" is availabiliy of boh parners o coninue he relaionship, specifically, he faculy member. When, as in he case of wo paricipans in his sudy, a CCP mus esablish a working relaionship wih a new faculy person each ime he course is augh, i becomes challenging o opimize oucomes for each semeser and impossible o move he parnership o he "Susaining" level. Given a coninued opporuniy for he wo parners o work ogeher, oher facors influencing "Susaining" include: (a) mainaining a close working relaionship wih coninued rus and respec; (b) shared goals a communiy boh he semeser and overall parnership levels; (c) coninued commimen o he parnership; (d) on-going communicaion and planning during and in-beween semesers when sudens are involved; (e) paricipaion by boh parners in he CETSL Advisory Group and (f) oher professional aciviies shared by he parners. Summary This chaper repored he resuls of hree phases of grounded heory analysis of 13 parners' percepions of heir service-learning relaionships wih a graduae nursing program. The firs wo phases involved daa analysis, coding, a group meeing of paricipans and wo rounds of member checking. Tweny caegories, he basic social psychological process (Connecing for Parnership), six conceps and wo core consrucs he was along wih heir relaed properies were idenified. Supporing quoaions were provided and research quesions were answered. In he hird phase of daa analysis, a descripive heory, Connecing for Parnership, proposed. The heory describes wo levels or phases of parnership wih a graduae

147 138 program of nursing: Teaming and Susaining. The levels were described and facors influencing each level idenified as well as overall oucomes. Three facors are relevan o each level: planning, communicaion and evaluaion.

148 139 Chaper V Discussion Inroducion The grounded heory approach o qualiaive research was used o examine he experiences of communiy organizaions concerning parnership wih a graduae nursing program. Resuls of inducive daa analysis (caegories, conceps and consrucs) were used o answer he research quesions, idenify he Basic Social Process (Connecing for Parnership) and develop a subsanive, descripive heory (Connecing For Parnership). The heory describes wo levels of parnership, Teaming and Susaining, along wih heir associaed processes, facors, oucomes. This chaper will include: Inerpreaion, Conclusions, Implicaions for Nursing, Limiaions, and Recommendaions. Inerpreaion Basic Social Psychological Process As daa analysis proceeded hrough Levels II and III of Coding, he researcher made several observaions concerning he relaionships being explored in he sudy: (a) he basic social psychological process (BSP) described by he paricipans was heir "parnership" wih an MSN program, (b) he erm "parnership" was being used by boh he researcher and he paricipans in a generic sense, no unlike use of he erm "Kleenex:" for facial issue and (c) alhough all bu one paricipan expressed saisfacion wih he relaionships, few of he academic-communiy parnerships (ACPs) explored in he sudy me he "Principles of Parnership" described by organizaions such as CCPH. Thus, organizing or caegorizing hem, as well as comparing hem o ACPs described in he lieraure, was difficul.

149 140 In seeking a label for he BSP, he researcher endeavored o link he relaionships described by he paricipans wih he erm paricipans used o describe heir relaionships. Thus, "Connecing for Parnership", was chosen. Connec denoes ajoining ogeher, a relaionship, or a rappor wih he inenion of parnership. Review of he lieraure revealed several frameworks concerning CAPs. One framework (Enos and Moron, 2003) acknowledged he occurrence of more han one level or ype of CAP. Enos and Moron (2003) chose, however, o idenify wo ypes of parnerships, discussed below, raher han a single label for he overall process. Levels ofparnership As noed above, resuls of his sudy revealed ha en of he 13 parnerships were applied paricipans repored saisfacion wih he process and posiive oucomes and he hireenh had informal, one-semeser, one faculy-one communiy conac person relaionships. Ye, 12 of 13 a one CCP-one faculy person relaionship, had been acive for hree semesers, had become lessons learned o a subsequen successful parnership. One parnership in his sudy, also solidified wih commimen o a long-erm relaionship and had shared goals for improvemen of he parnership iself. Two oher parnerships appeared o be ransiioning o a higher level of commimen. Thus, wo levels of parnership were idenified: "Teaming" and "Susaining". The largely descripive lieraure peraining o service-learning and ACPs in undergraduae and graduae Addiionally, he findings suppored Enos and Moron's (2003) framework for wo ypes of nursing educaion was congruen wih hese findings a he connecing level of parnership. parnerships, "Transacional and Transformaional Relaionships". However, several crieria for ransformaional relaionships were more expansive han he "Susaining" level idenified in his sudy. Enos and Moron (2003. p ), in describing heir preliminary ypology, a "Framework for Developmen of Campus-Communiy Parnerships", noed ha managing

150 141 places significan sress on he resources of boh campus and communiy parners. They sugges service-learning programs such as "one ime evens and placemens" and "shor-erm placemens" ha while mos one semeser placemens are sufficienly cos effecive o be seen as worhwhile by communiy parners, hey are no likely o "generae new resources or knowledge"(enos and Moron, 2003, p. 28). No sudies were found ha examined he effeciveness, in erms of boh resource uilizaion and oucomes, of"ransacional"-ype parnerships. Sages ofparnership Resuls of he sudy indicaed ha he level, Teaming, had five sages: (a) Ready o commi?, (b) geing o know you, (c) Suden orienaion o he communiy organizaion, (d) We're underway, and (e) We did i!. I is noable ha hree of he five sages occur before is described planning and implemenaion ofhe acual suden projecs begins. A sixh sage, Looking Ahead, a ransiion o coninuing he relaionship and he second level of parnership, Susaining. Two publicaions (Jacoby, 2003a; Bejarano, Balcazar, and Brewer, 2002) also suggesed sages of ACPs, hough from very differen perspecives. The Campus Compac Benchmarks (Jacoby, 2003a) describe principles for muli-secor parnerships a he insiuional level while he Bejarano, Balcazar, and Brewer (2002) aricle suggess a model, he Five Sage Process for Change", ha evolved from a parnership wih muliple members and a federally-funded, caalys fellow. Addiionally, Enos and Moron (2003) suggesed wo ypes ofparnerships. Despie, heir differen perspecives, he sages discussed in each aricle parallel hose idenified in his sudy as in Table 9. Teaming Ready o commi. The erms, Ready and Commi, refer o he key aciviies ofhe firs phase of"eaming". The iniial link occurs beween he communiy conac person (CCP) and he facuiy member and, in his sudy, was generally iniiaed by he MSN program. Specific characerisics

151 Table 9 Comparison of Sages of Academic-Communiy Parnerships "Connecing for Parnership" (curren sudy) Teaming 1. Ready o Commi 2. Geing To Know You 3. Suden Orienaion 4. We're Underway Campus Compac Benchmarks (Jacoby, 2003) 1. Designing he Parnership 2. Building Collaboraive Relaionships "Five Sage Process for Change" (Bejarano, Balcazar, and Brewer, 2002) 1. Geing Togeher 2. Building Trus 3. Developing A Sraegic Plan 4. Taking Acion Enos and Moron (2003) 1. Transacional Parnerships We Did I! Susaining 6. Looking Ahead! 3. Susaining Parnerships Over Time 5. Going To Scale 2. Transformaional Parnerships of he faculy person and CCP were idenified which appeared o faciliae esablishmen ofhe relaionship. The CCPs: were in professions of nursing, educaion or social services had exensive experience in heir profession; had been employed by heir organizaion for 4 or more years; and held a posiion of formal or informal leadership hrough which hey were familiar wih he mission, srucure, services, needs, resources, saff and cliens ofhe organizaion. The paricipans indicaed ha faculy should be familiar wih service-learning and experienced in eaching he course. Paricipans indicaed ha boh he CCP and he faculy person should be enhusiasic abou he parnership and commied o devoing he ime and effor necessary for engaging in parnership wih he oher organizaion. Addiionally, paricipans also noed ha i is helpful for he communiy organizaion o be commied o collaboraion and suppor of educaion as well.

152 143 However, ha becomes a more imporan facor in susaining he parnership and will be discussed furher in ha secion. Paricipans believed sudens should also a leas accep he service-learning aciviy and he parnership, a leas during he ime hey are involved. Lile was found in he lieraure concerning characerisics of faculy and CCPs ha will faciliae he CAP or he process by which parnerships are iniiaed. In heir Sage II, Campus Compac Benchmarks referred o he need for "energeic leadership and inspiraion" (Jacoby, 2003, p. 11). Bailey (2002) indicaed ha sudens should wan o playa role in he work of he paricular agency bu did no refer o faculy and CCP. Oher sources (Jones, 2003, Leiderman, e ai., 2003 and Enos and Moron, 2003) referred o he imporance of ineres in and commimen of ime o developing he parnership. Jones (2003) observed ha ACPs are generally iniiaed in order o implemen a service- learning aciviy. Jones (2003) suggess ha his approach may be effecive in he shor erm bu does no necessarily faciliae a long erm relaionship and proposes ha ACPs be developed firs and hen lead o aciviies such as service-learning. The findings of his sudy indicaed ha for en of he paricipans he relaionship was iniiaed by he MSN program (faculy, suden, or hrough he CETSL Advisory Group) in order o carry ou he course-based service aciviy. Two paricipans linked wih faculy a an MSN program-sponsored insiue on service-learning. One paricipan approached he school of nursing seeking assisance on a projec. Geing o know you. "Geing To Know You", is he period during which he firs opporuniy o iniiae four goals. faculy srucure, facors, idenified in his sudy, arises: 1) orienaion, 2) commimen, 3) reciprociy and 4) shared Leiderman, e ai., (2003) and Jones (2003) noed ha ime spen by he CCP and he person in iniial planning is key o success ofhe parnership. The poenial parners should mee or alk by phone and become sufficienly acquained as o each organizaion's resources and needs o deermine ifhey appear o be compaible. Jones (2003) idenified fi, as o boh he naure of he work o be done and he ime needed o complee i, as

153 one of six key facors in operaionalizing principles of parnership. Like he paricipans in his 144 sudy, she noed he challenge of meshing he schedules of academic insiuions wih hose of communiy organizaions ha operae year round or on differen schedules (such as K-12). If he faculy and CCP idenify a fi, hey should mee in person o orien he oher o heir I I organizaion's mission, srucure, needs, resources, culure, goals and expecaions. Several paricipans noed he value of funding o he parnership. The imporance of holding frank discussions concerning racial, ehnic, and economic e al. (2003) and Elias and Bui (2002). However, he lieraure did no reflec he need idenified inequaliies and heir causes was described by he paricipans in his sudy as well as Leiderman, I experiences, I I in his sudy for he parners (faculy and CCP) o have an equally in deph undersanding of he naure of he graduae sudens -i.e. as o he MSN program iself, he course, heir srenghs and resources (such as desire o learn, willingness o ask quesions, knowledge and experise, life ypes of projecs hey could do and providing heir own ransporaion) and heir consrains (such as limiaions on ime and definie opinions on specific opics). These rais were seen as having posiive and negaive influences on he success of he parnerships. Principles of Parnership (Honne and Poulson, 1988; CCPH, 2000; and Jacoby, 2003a) as well as auhors, beginning wih Sigmon's early wriings on service-learning in 1979 and coninuing o Leiderman e al.'s (2003) findings on pariy in ACPs, have idenified he imporance shared goals, reciprociy and muual rus and respec o successful ACPs. Findings of his sudy were congruen wih he lieraure. Resuls of his sudy indicaed ha he exen of formal planning during he "Geing To Know You" phase varied among he paricipans bu ha I I I formal planning beween he faculy and CCP was preferred. Paricipans agreed wih auhors such as Bailey, Carpener and Harringon (2002, p. 435) who noed he ACP mus be a "win-win relaionship wih he needs of he sudens and communiy group receiving equal imporance". Paricipans placed clearly emphasized addressing communiy-idenified needs while also

154 I I,. 145 acknowledging ha sudens were more saisfied wih heir projecs when here was a close link beween hem and he course objecives. Orienaion ofsudens The hird sage in "Teaming" is orienaion of sudens o he communiy agency. Alhough he CCPs in his sudy noed sudens should undersand and accep service-learning and is role in heir course before beginning he projec, orienaion of sudens o he communiy organizaion received much more emphasis. Paricipans believed orienaion should include an on-sie componen and sufficien deph ha sudens would appreciae he mission and scope ofhe organizaion, resources, needs, where heir projec fi in, mee oher sakeholders (cliens and/or saff), and undersand he culure of he organizaion and he arge populaion (wheher saff or cliens). Paricipans sressed ha suden need his undersanding so ha heir aciviies can be geared o he arge populaion i.e. developmenal level, language, reading level, socio-culural characerisics, values, expecaions, ec. I is preferable ifhe arge group has inpu ino planning of he projecs. The imporance of suden orienaion was noed by Elias and Bui (2002) and Seifer and Vaughn (2002) paricularly in relaion o he culure ofhe arge group. Two of Elias and Bui's (2002) facors in successful relaionships, responsive and respecful, relae o his issue. However, i seemed o be an especially challenging aspec ofhe parnerships in his sudy due o consrains on he ime of he MSN sudens and he paricipans saw orienaion as essenial o success ofhe I projecs. We're underway The fourh sage in "Teaming" is "We're Underway". Paricipans saw his sage as involving several key aspecs: (a) final decisions on suden projecs ha are realisic, mee communiy-idenified and suden learning needs and ap ino MSN sudens' knowledge and skills, (b) develop a specific, wrien plan wih defined roles; responsibiliies, and oucomes; a imeline; and is agreed upon by all; (c) on-going communicaion is regular, effecive, and uses

155 I 146 I roues feasible for all parners - i.e. a weekly repor; (d) everyone follows he plan; (e) here is flexibiliy bu no changes are made wihou agreemen by all. Some CCPs discussed general ideas for projecs wih he faculy person and negoiaed he specific projecs wih he sudens so as o inegrae heir ineress and skills. Ineresingly, he wo of he hree parners who specifically menioned hey negoiaed projecs wih he sudens were in Level II, Susaining he Parnership, and he hird was highly commied o working wih MSN sudens bu had no worked wih one faculy person for more han one semeser. CCPs in his sudy each ook several roles such as liaison, coordinaor, and learner during planning and implemenaion ofhe suden projecs. Several noed hey learned from he faculy, sudens and projecs. They also fel hey could be educaors o he sudens, paricularly in ailoring sudens I have been due o ime consrains or he CCP no being seen in ha role. CCPs recommended pracice any presenaions wih hem before he official day. Paricipans in his sudy were in clear agreemen wih auhors such as Leiderman e al. (2003), Jones (2003) and Elias and Bui (2002) as well as he CCPH Principles of Parnership as o he criical role ha effecive, on-going communicaion plays in successful parnerships. The presenaion skills o he needs of he group, bu were no used as ha ype of resource. This may relinquish sudy findings also suppored Leiderman e al. (2003) and Jones (2003) in heir calls for faculy o conrol and inegrae he experise of communiy parners in faciliaing suden learning experiences - boh a he communiy agency as well as in he classroom. However, none of he lieraure reviewed for his sudy described he specifics of facors influencing parnerships (such as a wrien plan wih imeline) idenified in his sudy. We made i! The final sage in "Teaming" is "We Made I". Paricipans indicaed he relaionships were ofen rushed and ended raher abruply a he end ofhe semeser. Evaluaion, if done a all, was an informal discussion beween he CCP and faculy member. However, several (including I he one in Level II, Susaining he Parnership) saw evaluaion involving all sakeholders as

156 I I 147 imporan. Those who aended he group meeing uniformly agreed ha reflecion and celebraion are also imporan. They had no been fully aware ha reflecion was a defining characerisic of service-learning and saed hey would like o be involved in i in he fuure. Evaluaion and celebraion are recurren hemes in principles and frameworks of CAPs (Jones, 2003; Seifer, 2002; Gelmon, e ai., 2001; Jacoby, 2003a); Jones (2003) liss evaluaion and assessmen as one of six condiions necessary o pu "principles of parnerships o work". Gelmon, e al., (2001) noed ha effors o assess he impac of service-learning parnerships had cenered around educaional oucomes. As discussed in Chaper II, hey recognized he need o assess he parnership iself and is impacs on all sakeholders, and hey developed and implemened a communiy-level, muli-source assessmen marix for improvemen of parnership performance (Gelmon e ai., 2001). Paricipans described a number of oucomes of parnership a he "eaming" level. Primary oucomes included conribuions made o he communiy organizaion (mission and goals) hrough compleion of he MSN sudens' projecs as well as learning by he sudens specific o he projec. In some cases, paricularly where he paricipan had worked wih muliple groups of sudens (in one or more semesers), he balance of conribuions versus learning varied from nearly equal o more on he suden learning end of he scale. A number of secondary oucomes were described by one or more paricipans. In order of frequency hey included: I paricipan oucomes such as personal/professional growh including learning from he sudens, fulfill responsibiliies o alma maer and/or profession, developed professional relaionship wih faculy member; MSN sudens learning abou he agency and is services; benefis of funding suppor beyond he projecs hemselves; longeviy of he suden projecs; and paricipan hopes MSN suden will work for he agency in he fuure. Research and heoreical lieraure peraining o ACPs and service-learning have described oucomes similar o hose indicaed above. Enos and Moron (2003, pp ) indicaed ha posiive oucomes may occur wih "ransacional"-ype parnerships. They do no

157 ~ However, describe he specifics of hose oucomes bu indicae hey relae o "saisfacion of immediae needs", are "insrumenal" and designed o complee a ask "wih no greaer plan or promise". The paricipans in his sudy described similar oucomes in relaion o he sudens' projecs. hey described a number of secondary oucomes for hemselves, personally and professionally, as well. As discussed in Chaper II, numerous oher auhors have described, in anecdoal and research lieraure, benefis o sudens from service-learning and ACPs. Few research sudies, and none in undergraduae and graduae nursing educaion, have described he specifics ofoucomes for he communiy parners idenified in his sudy ha may accrue from I shor-erm parnerships. Susaining The Parnership In his sudy, he one or wo relaionships ha could be considered o be a he susaining level had been mainained for hree or more semesers. In hese relaionships, he CCP and faculy person and he organizaion were commied o coninuing he parnership, and were characerized by muual rus and respec, reciprociy, and aciviies designed o improve he parnership iself and/or disseminae he sory ofhe relaionship. Moron and Enos (2003) were he only auhors found in he lieraure who addressed, in a heoreical way, he realiy ofwo ypes of parnerships revealed in his sudy and in descripive 148 lieraure. Oher auhors (Leiderman e al., 2003, Jacoby, 2003a, and Jacoby, 2003b) described successful ACPs as having he characerisics of Enos and Moron's (2003) "ransformaional" influencing level. However, hey did no acknowledge ha many parnerships do no necessarily evolve o ha level ye repor posiive oucomes. Paricipans in Leiderman e al.'s (2003, p. 9) summi idenified five facors as srongly heir decisions o ener a parnership or remain wih i: (a) "esablished infrasrucure such as presence ofa coordinaing eniy and sufficien saffing o handle he scope and scale of he communiy engagemen work, (b) adminisraive buy-in and suppor, (c) hisory of own/gown relaionship, (d) rus and accounabiliy and (e) clear goals and expecaions".

158 Paricipans.. I 149 Several of hese were refleced by he curren sudy, i.e. 1,2,4 and 5. In he case of he sudy, one and wo could be inerpreed as he MSN Program adminisraive suppor for he projec, funding for he overall projec as well as several of he parnerships, he CETSL Advisory Group, and faculy buy-in. who were members of he CETSL Advisory Group srongly recommended i and, again, he wo closes o he "Susaining" level were acive members of he group and several ohers who hoped o achieve a long-erm parnership, were as well. As noed earlier in his secion, Bailey, Carpener, and Harringon (2002) emphasized he key role an advisory group can I and I educaional insiuion. Developing a working relaionship characerized by reciprociy, muual rus and respec, shared goals was idenified by paricipans in his sudy as a key facors in successful play in planning, implemenaion and evaluaion of he service-learning program wihin he parnerships and was discussed earlier under "Geing o Know Your". Commimen o aking he ime o mainain and enhance he relaionship is also key o susaining parnerships as well. I Leiderman e al. (2003, p, 14) used he erm "pariy" and idenified messages campus parners may send ha lead o communiy parners "feeling used and (o) srained relaionships": (a) campus parners do no fully undersand he communiy organizaion or is cliens, (b) in a crunch, educaional needs ake precedence over communiy needs, (c) he communiy parners are I I no respeced by he campus and (d) he engagemen effor is for show (i.e. requiremens or public relaions) and no a genuine effor a engagemen. Lasly, heoreical lieraure (Seifer, 2000; Jacoby, 2003a; Jacoby, 2003b; Leiderman e a\., 2003; and Enos and Moron, 2003) views susained parnerships as having an insiuional level of commimen by boh parners. In he case ofhis sudy, several paricipans idenified he need for srong suppor of heir effors by heir organizaion's leadership and hose who paricipaed in he Advisory Group noed hey had increased awareness of suppor of he parnerships by he educaional insiuion.

159 I 150 This sudy accomplished is purpose, i.e. o conribue o he need for research and heory Conclusions I developmen concerning communiy parners' perspecives of paricipaion in ACPs involving graduae nursing educaion and answered he research quesions concerning he process and facors influencing such parnerships. The resuls ofhis sudy sugges ha, for he 13 parnerships represened by he paricipans, he process was bes described as "Connecing for Parnership". There were wo levels of parnerships, Teaming Up and Susaining. Teaming Up is he mos common level of parnership. I is characerized by a shor erm imeframe and five sages which progress from Are You Ready? hrough "We Made I". Each sage is influenced by cerain facors including communicaion, consideraion ofhe oher parners' culure, careful planning and a close working relaionship. Susaining implies commimen a boh he individual faculy/ccp and organizaional levels o a long-erm relaionship wih effors direced oward coninued reciprociy and enhancing he parnership iself. The findings of his sudy provide evidence o suppor recen heoreical lieraure regarding service-learning in higher educaion as o: (a) wo levels of communiy-academic parnerships, (b) he sages of parnerships, and (c) facors influencing heir success. I is ineresing o noe ha facors idenified by paricipans in his sudy as influencing heir largely informal, shor erm relaionships were very similar o hose seen as influencing long-erm, highly shared goals, planning, reciprociy and evaluaion. Communicaion, in is many shapes and forms, appears o be he single, overall facor in success of boh shor and long erm ACPs. Paricipans in his sudy raised opics no addressed in oher lieraure: (a) characerisics of he CCP and faculy person ha faciliae he relaionship; (b) he key role pre-planning by he srucured, muli-secor parnerships. These included: communicaion, commimen, orienaion, faculy and CCP plays in success of ACPs, (c) he need o undersand and consider he unique asses and consrains of he MSN suden, (d) he key role of suden orienaion o he

160 151 I communiy organizaion, (e) ha communiy parners value ACPs and are willing o devoe he ime o making hem succeed bu desire clearly delineaed, specific guidelines for he process I I I I I such as a one-page overview of service-learning, a plan for communicaion, and a form for a wrien plan wih imeline. Implicaions for Nursing While he findings of he sudy sugges a descripive heory and a number of specific sraegies for opimizing shor and longer-erm communiy-academic parnerships wih a graduae nursing program, hey reflec only he communiy perspecive and i canno be said heir implemenaion will lead o successful parnerships. Transferabiliy offindings Professional Nurses Beyond he Sudy Seing The sudy findings may have relevance for professional nurses such as: (a) faculy involved wih service-learning and ACPs in MSN, BSN, Associaed Degree, Diploma programs and (b) professional nurses pracicing in communiy based seings. Seven of he 13 paricipans in his sudy were professional nurses in communiy-based pracice. A key sub-populaion of he second group is generaliss and specialiss in Communiy/Public Healh Nursing whose roles and funcions specifically include engaging in parnerships, communiy building, and ransdisciplinary collaboraion. Aspecs ofhe findings mos likely o be ransferable o nurse educaors and nurses who pracice in communiy based seings include: 1. The poenial benefis ofcommuniy-academic parnerships wih an MSN program for I faciliaing suden learning as well as enhancing services provided by communiy organizaions. 2. Two levels of parnerships were idenified: Teaming and Susaining. "Teaming"(shorerm, informal parnership) was he mos frequen level.

161 4. 3. "Teaming", is composed of five sequenial sages and influencing facors (communicaion, commimen, shared goals, orienaion, planning and reciprociy). 152 and I I Characerisics of faculy and communiy-based organizaions ha faciliae ACPs. 5. Preliminary planning by he CCP and faculy person is essenial o opimizing success of he relaionship and communicaion appeared o he overriding facor hroughou all sages. 6. The key imporance of each parner (including sudens) being horoughly informed of respecing each oher's organizaion, mission, resources, needs, and culure. This is paricularly rue in erms ofhe unique srenghs and consrains MSN sudens bring o ACPs. 7. The uiliy of qualiaive research in providing evidence for he value of ACPs and service-learning in implemening course objecives and organizaional missions, he advanages and challenges o hese processes and pracical sraegies for implemening, disciplines ouside of nursing. Poenial users ofhe findings include faculy, adminisraors and communiy service saff in higher educaion; leaders in communiy organizaions; hose acive in faciliaing communiy service (i.e. AmeriCORPS) and funders of boh ypes oforganizaions. hem. Non-nursing Disciplines The findings of his sudy may have a leas as much relevance and ransferabiliy o nonnursing disciplines as hey do for nursing. Six ofhe 13 paricipans in his sudy were from hose in non-nursing disciplines may be informed ofhe key role shor and long-erm ACPs wih Informaion hey may learn and uilize includes ha discussed for nursing. Addiionally, I an MSN program can play in promoing heir organizaions' missions. These poenial conribuions would seem o be especially imporan as several paricipans noed ha collaboraion was inegral o implemenaion of heir organizaion's missions and funders value communiy-based organizaions ha engage in collaboraion.

162 Limiaions 153 Mehodological Limiaions There are several reasons for mehodological limiaions in generalizaion of he sudy. Firs, I he purpose of he sudy was o examine communiy parners' perspecives of paricipaion in ACPs involving graduae nursing educaion. Grounded heory mehods were appropriae o he purpose and he purpose was me. However, i was done wihin he seing of one graduae nursing program. Thus, inheren o grounded heory research, he findings have direc relevance only for he sample in he sudy. Second, cerain sraegies used in qualiaive research such as purposeful sampling may limi generalizaion of findings. I Third, he seing for his sudy was he ACPs wihin one graduae nursing program and he researcher was no able o inerview all organizaions involved in he projec. Fourh, for his sudy, only he perspecives of he key conac persons a he communiy organizaions were sough. However, parnerships are dynamic relaionships ha, in addiion o he CCP, faculy, and sudens may include ohers such as agency saff and cliens. Their perspecives on he process of parnership migh have differed from hose ofhe communiy conac persons. The fifh mehodological resricion ceners he limied size ofhe sample and volume of inerview daa. Each paricipan was inerviewed once and one represenaive ofeach parnership was inerviewed. A deeper level of heoreical sauraion migh have been obained had he researcher been able o conduc a follow up inerview and had a larger, more diverse sample. This could have been accomplished in one or boh of wo ways: (a) follow-up inerviews of paricipans, especially hose early in he sudy and (b) a larger number of paricipans. Follow-up inerviews migh have allowed he researcher o more effecively implemen Glaser and Srauss' (1967) echnique ofheoreical sampling based on he emerging caegories: "How would you describe a successful parnership wih a graduae program of nursing" or "How would you know if a relaionship wih a graduae program ofnursing was no a parnership?" or, for parnerships lasing one semeser, "Why has he parnership no been coninued?" and "Wha would need o

163 happen for you o work wih he school of nursing on a long-erm basis?". I was anicipaed he 154 parnership group meeing migh serve his purpose. However, hose who aended hearily agreed wih he findings and seemed o have lile o add. Theoreical Limiaions Reasons for heoreical limiaions o generalizaion of findings of his sudy are linked o he use of he grounded heory approach o qualiaive research. As conceived by Glaser and Srauss (1967) grounded heoriss search for, and seek o undersand and predic, social processes presen in human ineracion. In he case of his sudy, he human ineracion was communiy organizaions' parnership wih a graduae nursing program and he basic social process was "Connecing for Parnership". Grounded heory research may elici wo ypes of heories: formal and subsanive. Subsanive heories are generaed for a specific, circumscribed, and empirical area of inquiry and may be used o generae formal heories. Thus, subsanive heories, such as he one ha emerged from he curren sudy, will have specific relevance only for he sample. However, cerain procedures were underaken during daa collecion and analysis o promoe rigor of he findings and faciliae possible generalizaion o oher seings. The second heoreical limiaion is relaed o he wo levels of parnership in he proposed heory, "Connecing for Parnership". The findings of his sudy, descripive repors of service-learning in nursing (see Chaper II) and he Enos and Moron (2003) framework indicae wo ypes of parnerships for service-learning of which he more informal, shor-erm ype predominaes. However, in none of hese repors, are he reasons for shor imeframe or apparen lack of coninuiy ofhe relaionship discussed. In he case of his sudy, one possible reason for he apparen lack of coninuaion of a is dissaisfacion of eiher or boh parner wih he process and/or oucomes or oucomes were no cos-effecive in erms ofime, resources and effor required. According o he resuls of his sudy, ha did no seem o be an issue, as leas from he communiy perspecive. Oher possible reasons, several of which may no be under he direc conrol of he communiy

164 155 conac person, include: (a) lack ofa sufficienly srong level of commimen o pursue he relaionship despie challenges o i (i.e. "I worked ou ok bu... "), (b) he course is augh once a year and had no been augh again afer he firs semeser ofparnership, (c) urnover in faculy and agency saff, (d) change in communiy organizaions' prioriies and/or suppor of he parnership, (e) lack of resources - i.e. funding for parnership is depleed, (f) he closeness of "fi" is no mainained, and (g) lack ofrequired legal agreemens beween educaional and communiy organizaions Direcions for Fuure Research Grounded heory research is ypically used when lile is known abou a paricular opic and he researcher anicipaes he findings will se he sage for addiional research. This sudy of communiy organizaions' perspecives of parnership wih a graduae program of nursing addressed a opic abou which no lieraure had been published and suggess addiional research in several arenas. The presen sudy examined only he perspecives ofhe communiy parners. However, CAPs are dynamic relaionships composed ofa leas one oher parner (he faculy person) and possibly more (sudens, oher agency saff, cliens and he larger insiuion). I would be beneficial o explore perspecives of oher sakeholders in he parnerships and compare wih he findings ofhis sudy. Addiionally, replicaion of his sudy in oher seings of graduae nursing programs engaged in service-learning and CAPS as well as nursing educaion, healh professional educaion and he broader arena of higher educaion and comparison wih he findings ofhis sudy would provide evidence for similariies and differences of findings of his sudy. Alhough here has been increased aenion o he communiy perspecive of communiyacademic parnerships, he lieraure is largely heoreical. There is a need for research sudies designed o examine he various heories, concepual frameworks, processes and facors described by auhors such as Cruz and Giles (2000), Jensen and Royeen (2000), Gelmon e al. (2001), Elias and Bui (2002), Enos and Moron (2003) and discussed in Chapers I and II of his repor.

165 1. Wha is he curren sae of knowledge relaing o process and oucomes in his arena? An iniial exploraion migh begin wih a mea-analysis of exising empirical, heoreical and descripive lieraure. 156 Review of available lieraure revealed numerous repors of service-learning implemened hrough relaionships wih communiy organizaions. All repors (largely anecdoal and focused on he educaional perspecive) indicaed posiive oucomes for sudens and communiy agencies. Some auhors referred o he principles of parnerships (Appendices A, Band C) as a guiding force ye many of he relaionships are referred o as "placemens" or "communiy sies" raher han being viewed as parnerships and hose ha are labeled parnerships are of he "Connecing for Parnership" or Transacional ype. Mos published lieraure on service-learning in nursing educaion referred o pre-licensure educaion; six repors of service-learning in graduae nursing educaion were found.. Much ime, effor and money (boh indirec and direc) is being devoed o implemenaion of service-learning and ACPs in nursing. There is a clear need for empirical evidence relaing o a number of research quesions: 3. There is a need for heoreical frameworks for service-learning and ACPs in nursing 2. Wha is he impac, in erms of invesmen and oucomes, of service-learning and ACPs in nursing educaion? Are here differences beween differen ypes of parnerships? (i.e. connecing or ransacional and susaining or ransformaional?). This should be answered wih rigorous evidence ha incorporaes all sakeholders and looks a boh resource uilizaion as well as oucomes. Gelmon e ai.'s (2000) assessmen marix would be a good saring poin alhough i does no incorporae resource uilizaion. educaion suppored wih empirical evidence. I is no likely ha one model will "fi all" and ha separae models are needed for various ypes of nursing educaion programs and levels of parnerships. This process should sar wih sudies designed o I

166 examine principles of parnership such as hose pu forh by CCPH. These principles 157 appear relevan. However, no sudies for, or empirical sudies of, hese principles were found. Are hey realisic and ifso, for wha levels of parnerships? Wha processes and facors are necessary o achieve he principles. 4. Longiudinal inervenion sudies are needed o demonsrae he oucomes and effeciveness of communiy academic parnerships for all sakeholders including cliens and funders. Communiy organizaions, including hose in his sudy, repor increasingly limied resources and reliance on collaboraions wih diverse parner organizaions o accomplish heir missions and goals. Can schools of nursing, especially graduae programs, be a key player in hese relaionships while meeing heir primary goals relaed o nursing educaion? If so, wha are mos effecive approaches in erms of processes, oucomes and coss? Only well-designed research sudies can provide he answers o hese quesions. 5. Those who have engaged in service-learning and ACPs enjoy "elling heir sories". However, hese sories need o be boh suppored wih empirical evidence and repored in venues accessible o hose ineresed in he findings. Peer-reviewed, mainsream journals are he ideal forma and reach he wides audience. Informaion ha is anecdoal and/or disseminaed in formas such as pamphles and presenaions a regional or naional professional meeings may be imporan and/or pracical bu i is difficul o access hem and assess heir credibiliy. Addiionally, communiy parners represen many disciplines and, if hey publish in heir professional venues, ohers who migh be ineresed in he findings may no encouner hem. CCPH has addressed his issue by publishing monographs of presenaions a heir annual meeings and encouraging co-auhoring of repors by all parners. However, heir repors are generally of large scale projecs and also lack empirical evidence.

167 Summary 158 This sudy found ha, for he sample, he process of parnership by communiy organizaions wih a graduae nursing program was described as "Connecing for Parnership". Two levels of "Connecing for Parnership" were idenified: Teaming and Susaining. The firs level, which perained o mos paricipans, was a process wih five sages: Ready o Commi?, Geing o Know You, Suden Orienaion, We're underway, and We did i! Paricipans idenified several facors as key o success of"connecing for Parnership": effecive, on-going communicaion; commimen; orienaion, shared goals; planning; reciprociy; and evaluaion. Paricipans sressed he imporance of all sakeholders being involved hroughou he parnership. Less was discovered abou "Susaining" as only one or wo paricipans fell ino his caegory. Paricipans a his level indicaed hey were engaged in aciviies designed o enhance he parnership iself as well as each semeser's suden aciviies. Commimen, communicaion, reciprociy, planning and evaluaion appeared o coninue o be key facors in longer-erm parnerships. Sudy findings were inerpreed in erms of relevan, available lieraure. The inerpreaion focused on several aricles and a book published since he sudy was iniiaed and closely relaed o he opic of he sudy. The lieraure was heoreical in naure and he findings of he sudy suppored he lieraure. Because he lieraure deal wih he broad area of higher educaion, his sudy found some facors relaed o he unique culure of graduae nursing educaion and is sudens. Inerpreaion ofhe findings was followed by conclusions. The findings of his sudy have specific relevance for he sudy sample and may be ransferred o he sudy seing as well as o oher broader seings. The sudy has implicaions for professional nurses in nursing educaion and communiy-based pracice as well as professionals in various disciplines such as social service and Kindergaren-l 2 educaion who parner wih nursing educaion programs.

168 159 consrains inheren in he grounded heory approach o qualiaive research and were largely Reasons for limiaions as o generalizaion of he sudy findings cener around he planning phase ha he sudy will se he sage for fuure research. Based on he findings of his sudy, as well as he curren lieraure peraining o academic-communiy parnerships, several direcions for furher research were discussed paricularly in regard o parnerships anicipaed during planning of he sudy. The grounded heory researcher anicipaes from early in involving programs of graduae nursing educaion.

169 160 References American Associaion of Colleges of Nursing). (1999). Nursing educaion's agenda for he 21 scenury. Rerieved June 13, 2002 from: hp:// Annells, M. (1996). Grounded heory mehod: Philosophical perspecives, paradigm of inquiry, and posmodernism. Qualiaive Healh Research 6(3): Associaion of Sae and Terriorial Direcors ofnursing. (2000). Public healh nursing: A parnerfor healhy populaions. Washingon, D.C.: American Nurses Publishing. Bailey, P., Carpener, D., & Harringon, P. (2002) Theoreical foundaions of service-learning in nursing educaion. Journal ofnursing Educaion 41(1 0): References marked wih one aserisk indicae lieraure included in he review of undergraduae nursing educaion; wo aserisks indicae graduae nursing educaion. *BaiJey, P., Carpener, D., & Harringon, P. (Eds.). (1999). Inegraing communiy service ino nursing educaion. New York: Spring Publishing Company. Baker, B. (1997). In parnership: The communiy perspecive in Seifer, S. & Connors, K.(eds.) A Guide For Developing Communiy-Responsive Models in Healh Professions Educaion. San Francisco, CA: Communiy Campus Parnerships for Healh. Baker, C., Wues, J., & Sern, P. (1992). Mehod slurring: he grounded heory/ phenomenology example. Journal ofadvanced Nursing 17: Baisoni, R. (2001, working draf). Civic engagemen across he curriculum: A Resource book for service-learning faculy in all disciplines. (Personal communicaion). Bejarano, C., Balcazar, H., & Brewer, L. (2002) Parnership principles & bes pracices in he linkage of academia and pracice o address healh dispariies in Tarran Couny, TX. Parnership Perspecives, II(1): Summer, 2002, Benoliel, J. (1996). Grounded heory and nursing knowledge. Qualiaive Healh Research 6(3): *Bile, M., Duggleby, W., & Ellison, P. (2002). Implemenaion of he essenial elemens of service learning in hree nursing courses. Journal ofnursing Educaion 41(3): Bloxham, S. (1996). A case sudy of iner-agency collaboraion in he educaion and promoion of young people's sexual healh. Healh Educaion Journal 55: Boex, J. & Henry, R. (2001). Commenary: Principles o guide AHC-Communiy Parnerships. Academic Medicine 76(2): *Calliser, L. & Hobbins-Garbee, D. (2000). "Ener o learn, go forh o serve": Service learning in nursing educaion. Journal ofprofessional Nursing 16(3):

170 Channaz, K., (2000). Grounded heory: Objecivis and consrucivis mehods. In Denzin, N. & Lincoln, Y. (Eds.), Handbook ofqualiaive research (2 od ed.), (pp ) Thousand Oaks, CA: Sage Publicaions. 161 Chaudry, R., Prolivka, B., & Kennedy, C. (2000). Public healh nursing direcors' percepions regarding ineragency collaboraion wih communiy menal healh agencies. [Elecronic version] Public Healh Nursing 17(2): * Ciaccio, J. and Walker, G. (1998). Nursing and service-learning: The kobyashi maru. Nursing and Healh Care Perspecives 19: *Corbe, c., Seer, S., & Rappuchi, D. (2000). Creaing a "Win-Win" home care agencyuniversiy parnership. Caring, Nov. 2000: **Cohen, S. and Milone-Nuzzo, P. (2001). Advancing healh policy in nursing educaion hrough service-learning. [Elecronic version] Advances in Nursing Science 23(3): Council of Communiy Healh Nurses. (1985). Sandards ofcommuniy healh nursing pracice. Washingon, D.C.: American Nurses Associaion. Cruz, N. & Giles, D.(2000). Where's he communiy in service-learning research? Michigan Journal ofcommuniy Service-Learning: Special Issue, Fall, Deparmen of Healh and Human Services. (2000). Healhy people in healhy communiies: A guide o using Healhy People Rerieved June 11,2002: hp:// Dey, I. (1999). Grounding grounded heory: Guidelines for qualiaive inquiry. San Diego: Academic Press. *Drevdahl, D., Dorcy, K., & Grevsad, L. (2001) Inegraing principles of communiy-cenered pracice ino a communiy healh nursing pracicum. Nurse Educaor 26(5): Elias, T. & Bui, T. (2002) Trials, ribulaions, and lessons of parnerships. Parnership Perspecives 11(1): *Ellenbecker, c., O'Brien, E., & Byrne, K. (2002). Esablishing parnerships wih social services agencies for communiy healh educaion. Journal ofcommuniy Healh Nursing 19(1):1-6. *Ellenbecker, c., Byrne, K., O'Brien, E., & Rogosa, C. (2002). Nursing clinics in elder housing: providing access and improving healh care oucomes. Journal ofcommuniy Healh Nursing 19(1): Enos, S. & Moron, k. (2003) Developing a heory and pracice of campus-communiy parnerships. In Building Parnerships for Service-Learning (pp ). San Francisco, CA: Jossey-Bass. Eyler, J., Giles, D., & Gray, C. (1999). A a glance: Wha we know abou he effecs of Service-learning on sudens,faculy, insiuions, and communiies, Naional Service-Learning Clearinghouse (no ciy).

171 162 Ferrari, J. & Worrall, L. (2000). Assessmens by communiy agencies: How "he oher side" sees service-learning. Michigan Journal ofcommuniy Service-Learning Fall, 2000 (35 40). Flick, L, Reese, c., Rogers, G., Flecher, P., & Sonn, J. (1994). Building communiy for healh: Lessons from a seven-year old neighborhood/universiy parnership. Healh Educaion Quarerly 21 (3): Geschwind, S., Ondaaje, E., & Gray, M. (1997). Reflecing on campus-communiy relaions. Expanding Boundaries Vol II (Spring, 1997): Gelmon, S., Holland, S., & Shinnamon, A. (1998). Healh professions schools in service o he naion: Final evaluaion repor. Porland, OR: Porland Sae Universiy. Gelmon, S., Holland, B., Driscoll, A., Spring, A., & Kerrigan, S. (2001). Assessing servicelearning and civic engagemen. Providence, R.l: Campus Compac. Glaser, B. & Srauss, A. (1967). The discovery ofgrounded heory: Sraegies for qualiaive research. Chicago: Aldine Publishing Company. Glaser, B. (1978). Theoreical sensiiviy: Advances in he mehodology ofgrounded heory. Mill Valley, CA: Sociological Press. Glaser, B. (1992). Emergence vs forcing: Basics ofgrounded heory analysis. Mill Valley, CA: Sociological Press. *Hales, A. (1997). Service-learning wihin he nursing curriculum. Nurse Educaor 22(2): *Hammer, J., Wilder, B., Avery, G., & Byrd, L. (2002). Communiy-based service learning in he engaged universiy. Nursing Oulook 50(2): Hancock, T. (2001). People, parnerships, and human progress: building communiy capial. [Elecronic version]. Healh Promoion Inernaional 16(3), Honne, E. & Poulson, S.(1989). Principles ofgoodpracicefor combining service and learning (A Wingspread Conference Repor). The Johnson Foundaion. Rerieved: hp:// **Horak, B., O'Leary, K., & Carlson, L. (1998). Preparing healh care professionals for qualiy improvemen: The George Washingon Universiy/George Mason Universiy experience Qualiy Managemen in Healh Care 6(2): Howard, 1., Gelmon, S., & Giles, D. (2000). From yeserday o omorrow: Sraegic direcions for service-learning research. Michigan Journal ofcommuniy Service Learning. Fall, 2000: Holloway, A. (2002) Service-learning in communiy college nursing educaion. Journal of Nursing Educaion 41(10):

172 Huchinson, S. (1993). Grounded heory: The mehod. In P. L. Munhall & C. O. Boyd (Eds.), Nursing research: A qualiaive perspecive (pp ). New York: Naional League for Nursing Press. Jacoby, B. (2003) Fundamenals of service-learning parnerships. In Jacoby, B. and Associaes, Building Parnershipsfor Service-Learning (pp. 1-17). San Francisco, CA: Jossey-Bass. 163 Jacoby, B. (2003) Building service-learning parnerships for he fuure. In Building Parnerships For Service-Learning (pp ). San Francisco, CA: Jossey-Bass. Jacoby, B. and Associaes (2003) Building Parnerships for Service-Learning. San Francisco, CA: Jossey-Bass. Jensen, G. & Royeen, C. (2001). Reflecions on building communiy: A differen perspecive on academic-communiy parnerships using he Inegraion Marix. Journal ofallied Healh 30(3}: Johnson, S., Young, J., & Johnson, D. (1997). Agency percepions of service-learning: Voices from he communiy. Expanding Boundaries: Building Civic Responsibiliy in Higher Educaion Vol II (Spring, 1997)... Jones, S. (2003) Principles and profiles of exemplary parnerships wih communiy agencies. In Building parnerships for service-learning (pp ). San Francisco, CA: Jossey Bass. Kools, S., McCarhy, M., Durham, R., & Robrech, L. (1996). Dimensional analysis: Broadening he concepion of grounded heory. Qualiaive Healh Research 6(3}: Koplan, J. & Fleming, D. (2000). Curren and fuure public healh challenges. JAMA 284(13}: Krezman, J. & McKnigh, J. (1993). Building communiies from he inside ou: A pah oward finding and mobilizing a communiy's asses. Chicago: ACTA Publicaions. *Kulewicz, S. (2001). Service learning: Head Sar and a baccalaureae nursing curriculum working ogeher. Pediaric Nursing 27(1}: Lasker, R., Weiss, E., & Miller, R. (2001) Parnership synergy: A pracical framework For sudying and srenghening he collaboraive advanage. Millbank Quarerly 79 (2): Leiderman, S., Furco, A., Zapf, J., & Goss, M. (2003) Building parnerships wih college campuses: Communiy perspecives. Washingon, D.C.: The Council ofindependen Colleges. Lincoln, Y.S. & Guba, E.G. (1985). Esablishing Trusworhiness in Nauralisic inquiry. (pp ). Beverly Hills, CA: Sage. **Logsdon, M. C. & Ford, C. (1998). Service-learning for graduae sudens. Nurse Educaor 23(2}:

173 *Long, C. (2002). Academic and educaional parnerships can work for you. Home Healhcare Nurse 20(1): **Luz, J., Herrick, C. & Lehman, B. (200 I). Communiy parnership: A school creaes nursing ceners for older aduls. Nursing and Healh Care Perspecives 22(1): * Mayne, L. & Glascoff, M. (2002) Service learning: Preparing a healhcare workforce for he nex cenury. Nurse Educaor 27(4): McKnigh, J. (1995). The careless sociey: Communiy and is couneifeis. New York: Basic Books. *MilIer, M. & Swanson, E. (2002). Service-learning and communiy healh nursing: A naural fi. Nursing Educaion Perspecives 23(1): Moffa, S., King, M. and Sowan, M. (2002, May). Srenghening parnerships: CHN educaors and public healh nursing. Paper presened a he 2002 Naional Meeing ofhe Associaion ofcommuniy Healh Nursing Educaors. Melia, K. (1996). Rediscovering Glaser. Qualiaive Healh Research 6(3): Narsavage, G., Lindell, D. & Bachelor, H. (2001) Graduae educaion in nursing: Communiy engagemen develops personal and communiy learning. Nursing Educaion Perspecives (acceped). **Narsavage, G., Lindell, D., Chen, K., Savrin, C., & Duffy, E. (2002) Descripion and evaluaion ofa communiy engagemen iniiaive: Service-learning in graduae nursing educaion. Journal ofnursing Educaion 41(10): Public O'Neil, E. and he Pew Healh Professions Commission. (1998). Recreaing healh professionalpracicefor a new cenury. San Francisco, CA: Auhor. *Peerson, S. & Schaffer, M. (1999). Service-learning: A sraegy o develop group collaboraion and research skills. Journal ofnursing Educaion 38(5): Prolivka, B. (1995). A concepual model for ineragency collaboraion. IMAGE: The Journal of Nursing Scholarship 27(2): Prolivka, B. (1996). Rural sex educaion: Assessmen of programs and ineragency collaboraion. Public Healh Nursing 13(6): Prolivka, B., Kennedy, c., & Chaudry, R. (1997). Collaboraion beween local public healh and communiy menal healh agencies. Research in Nursing and Healh 20: Prolivka, B., Dresbach, S., Hemlich, J., & Ellio, M. (2001). Ineragency relaionships among rural early inervenion collaboraives. Public Healh Nursing /8(5): Healh Funcions Seering Commiee (1995). Public Healh in America: Vision, Mission, and Essenial Public Healh Services. From Planner's Guide, Naional Public Healh Week, 2000.

174 165 Punam, Quad *Riner, R. (2000). Bowling alone: The col/apse and revival ofamerican communiy. New York: Simon and Schuser. Council of Public Healh Nursing Organizaions. (1999). Scope and sandards ofpublic healh nursing pracice. Washingon, D. C.: American Nurses Publishing. M. & Beckenberg, A. (2001). Parnering wih a siser ciy organizaion for an inernaional service-learning experience. Journal oftransculural Nursing 12(3): *Rodgers, M. (2001) Service learning: Resource Allocaion. Nurse Educaor 26(5): Rogers, D. & Wheen, D. (1982) Iner-organizaional coordinaion: Theory, research, and implemenaion. Ames, IA: Iowa Sae Universiy. Rohman, M. (Ed.), Anderson, E. & Schaffer, J., saff wriers. (1998). Service maers: Engaging higher educaion in he renewal ofamerica's communiies and American democracy. Providence, RI.: Campus Compac. * Sacke, K., Hendricks, c., and Pope, R (2000). Collaboraion: An innovaive educaion/business parnership. The Case Manager, Nov/Dec.2000: *Schaffer, M., Maher, S., & Gusafson, V. (2000). Service-learning: A sraegy for conducing healh needs of he homeless. Journal of Healh Care for he Poor and Underserved 11(4): **Scheideberg, D. (1999). Service-learning wihin a midwifery curriculum. Journal of Nurse Midwifery 44(2): *Schneiderman, J., Jordan-Marsh, M., & Baes-Jensen, B. (1998). Senior ceners: Shifing suden paradigms. Journal ofgeronological Nursing 24(10): I Puing Sco, C. & Thurson, W. (1997) A framework for he developmen of communiy healh agency parnerships. Canadian Journal ofpublic Healh 88: *Sebasian, J., Davis, R., and Chappell, H. (1998). Academia as parner in organizaional change. Nursing Adminisraion Quarerly 23(1): Seifer, S. (2002) From placemen sie o parnership: The promise of service-learning. Journal of Nursing Educaion 41 (10): Seifer, S. & Connors, K., (Eds.). (1997). A guide for developing communiy-responsive models in healh professions educaion. San Francisco: UCSF Cener for he Healh Professions. Seifer, S. & Maurana, C. (2000). Developing and susaining communiy-campus parnerships: principles ino pracice. Parnership Perspecives:1(2): Seifer, S. & Vaughn, R (2002) Parners in caring and communiy: Service-learning in nursing educaion. Journal ofnursing Educaion 41(10):

175 I Sigmon, I I I I P. (1979). Service-learning: Three principles. Synergis, Spring, *Simoni, P., & McKinney, J. (1998). Evaluaion of service-learning in a school of nursing: Primary care in a communiy seing. Journal ofnursing Educaion 37(3): Sem, P. (1980). Grounded heory mehodology: Is uses and processes. Image 12(1): *Sernas, K., O'Hare, P., Lehman, K., & Mulligan, R. (1999). Nursing and medical suden eaming for service learning in parnership wih he communiy: An emerging holisic model for inerdisciplinary educaion and pracice. Holisic Nursing Pracice 13(2): Srauss, A. & Corbin, J. (Eds.). (1997). Grounded heory in pracice. Thousand Oaks, CA: Sage Publicaions. 166 Srauss, A. & Corbin, J. (1998). Basics ofqualiaive research: Techniques andprocedures for developing grounded heory. Thousand Oaks, CA: Sage Publicaions. I I I I I I I Srauss, A. & Corbin, J. (1998). Basics 1qualiaive research: Techniques andprocedures for developing grounded heory (2n. Ed.), Thousand Oaks, CA: Sage Publicaions. Vernon, A. & Ward, K. (1999). Campus and communiy parnerships: Assessing impacs and srenghening connecions. Michigan Journal ofcommuniy Service Learning, Fall, 1999: Weiss, E., Miller, R., & Lasker, R. (2001). Findingsfrom he Naional Sudy ofparnership Funcioning: Repor o he parnerships ha paricipaed New York: The Cener for Advancemen of Collaboraive Sraegies in Healh. Wells, K. (1995). The sraegy of grounded heory: Possibiliies and problems. Social Work Research 19(1): *Whie, J. (1999). Wellness Wednesdays: Healh promoion and service learning on campus. Journal ofnursing Educaion 38(2): *Whie, S. & Henry, J. (1999). Incorporaion of service-learning ino a baccalaureae nursing educaion curriculum. Nursing Oulook 47(6): *Whie, S., Fesa, L., Allocca, P., & Abraham, I. (1999). Communiy service-learning in an undergraduae psychiaric-menal healh nursing course. Archives ofpsychiaric Nursing 13(5): Wilson, H. & Huchinson, S. (1996). Commenary: Mehodological misakes in grounded heory. Nursing Research 45(2): Wolff, M., & Maurana, C. (2001). Building effecive communiy-academic parnerships o improve healh: A qualiaive sudy of perspecives from communiies. Academic Medicine 76(2):

176 Appendix A Wingspread Principles of Good Pracice for Combining Service and Learning An effecive program engages people in responsible and challenging acions for he 167 common good. An effecive program provides srucured opporuniies for people o reflec criically on heir service experience. An effecive program allows for hose wih needs o define hose needs. An effecive program clarifies he responsibiliies of each person and organizaion involved. I An effecive program maches service providers and service needs hrough a process ha recognizes changing circumsances. An effecive program expecs genuine, acive, and susained organizaional commimen. I An effecive program includes raining, supervision, monioring, suppor, recogniion, and evaluaion o mee service and learning goals. An effecive program insures ha he ime commimen for service and learning is flexible, appropriae, and in he bes ineress of all involved. An effecive program is commied o program paricipaion by and wih diverse Honne I populaions. and Poulson, 1989, p. 2.

177 AppendixB The CCPH Principles of Parnerships 168 a Parners have agreed upon mission, values, goals and measurable oucomes for he parnership. The relaionship beween parners is characerized by muual rus, respec, genuineness and commimen. need improvemen. The parnership balances he power among parners and enables resources among parners o be shared. There is clear, open and accessible communicaion beween parners, making i an The parnership builds upon idenified srenghs and asses, bu also addresses areas ha ongoing prioriy o lisen o each need, develop a common language, and validae/clarify, he meaning of erms. Roles, norms and processes for he parnership are esablished wih he inpu and agreemen of all parners. There is feedback o, among and from all sakeholders in he parnership, wih he goal of coninuously improving he parnership and is' oucomes. Parners share he credi for he parnership's accomplishmens. Parnerships ake ime o develop and evolve over ime. Source: Connors, K. and Seifer, S., 2000, pp. 7-8.

178 AppendixC Benchmarks for Campus-Communiy Parnerships 169 I Founded on a shared vision and clearly ariculaed values (Characerisics of genuine democraic parnerships) STAGE I: DESIGNING THE PARTNERSHIP a Beneficial o parnering insiuions I STAGE II: BUILDING COLLABORATIVE RELATIONSHIPS I Composed of inerpersonal relaionships based on rus and muual respec Mulidimensional: hey involve he paricipaion of muliple secors ha ac in service of a complex problem. Clearly organized and led wih dynamism. STAGE III: SUSTAINING PARTNERSHIPS OVER TIME Inegraed ino he mission and suppor sysems of he parnering insiuions. I Susained by a "parnering process" for communicaion, decision-making, and he iniiaion of change. Evaluaed regularly wih a focus on boh mehods and oucomes. Adaped from: Jacoby, 2003a, pp I I I I

179 ~ ~I c o 1"1'1 In Appendix D Dae: ---- Agency/Organizaion: Address: Faculy Advisor: ~ Faculy Insiuion/School: Course Name: u ṉ I Y F e e d b a 1. Have you had sudens who were engaged in experienial learning/servicelearning work a your agency before? Yes 0 No 2. How difficul was i o coordinae his experience wih he suden(s) and/or eacher? 1_ Very difficul 2_ Somewha difficul 3_ No difficul 3. Orienaion o he communiy experience is an imporan componen of service-learning. How well oriened o your agency and clien populaion were he sudens? 1_ Poorly 2_ Adequaely 3_ Excellen 4. Compared o your ypical voluneer or worker, how effecive were he sudens in he work hey did a your agency? 1 Less effecive 2 Neiher more nor less effecive 3 More Effecive 5. Compared o your usual managemen of voluneers/workers, how much ime and effor did you have o devoe o his experience? 1 No as much ime and effor 2 Abou he same amoun ofime and effor 3 More ime and effor 6. Do you hink sudens benefi from service-learning experiences? 1 Yes 0 No c 7. Would you choose o do a similar experience again? 1 Yes 0 No Commens

180 171 Appendix E - CWRU IRB Applicaion Aachmen A Quesion 1 The sample will include communiy organizaions (as of 12/1/02, N = abou 15) ha have parnered since Sepember, 2000, or are currenly parnering, wih he faculy and sudens of he Communiy Engagemen Through Service-Learning (CETSL) Projec ofhe MSN Program, Frances Payne Bolon School of Nursing, Case Wesern Reserve Universiy. There is one primary conac person for each agency. The goal of he sudy is o conduc a leas one inerview wih a paricipan from each organizaion. The researcher will call or , in alpha order by name of agency, he primary conac person for each agency (see Aachmen B). Conac persons will be recruied in he order in which hey respond o he phone calls: he purpose of he sudy will be explained and he individual asked o paricipae. The dae, ime, and locaion for he visi o he agency and for he inerview will be se based on he preferences of he paricipan. The agency visi and he inerview may be done on separae occasions. A confirmaion leer or (Aachmen B) will be sen o he paricipan along wih a copy ofhe Consen Form (Aachmen C). I ~ Recruimen will sop when all parner organizaions have been invied o paricipae. If he primary conac person of a parner organizaion is unable, or chooses no o paricipae, he snowball mehod of recruimen will be used. The primary conac person will be asked o sugges anoher member of he organizaion's saff who has had a direc working relaionship wih faculy and sudens of he MSN program. Those persons will hen be conaced and recruied in he above manner. Due o he naure of sampling and recruimen for qualiaive research, i is no possible o deermine in advance he number of males and females here will be in he sudy. Based on he researcher's pilo sudy and experience wih he CETSL projec, i is anicipaed ha mos of he paricipans will be female. Quesion 4 Audioapes will be made only wih consen of he paricipan and will be coded as o agency (alpha leer) and paricipan name (ficiious name). Paricipans will no be referred o by name during he inerview and will be asked o no refer o he name ofheir agency during he inerview and such informaion will no appear in he inerview ranscrip. Each agency will be assigned a code leer and each paricipan a ficiious name. The audioapes will be kep in a locked file drawer in he locked office ofhe co-invesigaor. The office and file drawer are accessible only o he co-invesigaor. The co-invesigaor will desroy he audioapes hree years afer he las disseminaion relaed o he research. See Quesion 5 for addiional informaion concerning confidenialiy. Quesion 5 To proec confidenialiy, paricipans will be assured ha informaion revealed during he inerviews is oally confidenial and will no be shared wih faculy, sudens, or oher saff a heir agency or any oher agency. Audioapes will be made only wih consen of he paricipan and will be coded as o agency (alpha leer) and paricipan name (ficiious name). Paricipans will be asked o refrain from references o heir name or he name of heir agency during he inerview and such informaion will no appear in he inerview ranscrip. Each agency will be

181 assigned a code leer and each paricipan a ficiious name. A shee wih descripive informaion for each paricipan (Aachmen D) will be kep in a locked file separae from he inerview ranscrip and he descripive informaion will be used for aggregae saisics only. No-one excep he invesigaor and he responsible faculy will read he ranscrips. In he wrien repor, and any publicaion or presenaion of he findings, any descripive informaion ha migh idenify an agency, paricipan, locaion or seing will be alered o proec confidenialiy. Any quoes will be modified so ha he paricipan and/or heir agency canno be idenified. As his is a qualiaive sudy, analysis will include idenificaion and coding ofemerging conceps. The audioapes, ranscrips, signed informed consen forms, field noes, and paricipan informaion shees will be kep in a locked file drawer in he locked office of he co-invesigaor. The office and file drawer are accessible only o he co-invesigaor. Compuer files will be password proeced. The researcher will mainain all maerials relaed o he sudy (i.e. audioapes, compuer files, field noes, ranscrips, consens, paricipan informaion shees) for hree years following final disseminaion relaed o he sudy. A ha ime hey will be desroyed. 172 I Quesion 6 The risks and inconveniences of paricipaion include: 1) he ime required o paricipae in he inerview and review a summary of he findings a a laer dae and 2) possible emoional discomfor wih discussion of negaive aspecs of he parnership. These risks and inconveniences are reasonable as he informaion gained may be used o improve he effeciveness of communiy academic parnerships by his and oher schools of nursing. Quesion 7 The benefis of paricipaion are ha he informaion may be used o help improve: 1) he paricipan organizaion's parnership wih he MSN Program of he Bolon School of Nursing, 2) oher communiy-based aciviies of he Bolon School and 3) communiy-academic parnerships by oher schools of nursing.

182 Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program of Nursing 173 " CWRU IRB Applicaion Aachmen B Recruimen Scrip (phone Call or ) Hello, my name is Debbie Lindell. I am a suden in he Nursing Docorae Program of he Bolon School of Nursing, Case Wesern Reserve Universiy. Your organizaion has been idenified has being a pas or curren parner in he Bolon School MSN Program's Communiy Engagemen Through Service-Learning projec and you have been idenified as he key conac person for he parnership. I am ineresed in learning abou your views of your experience of parnership wih our MSN faculy and sudens. To do so, I would like o visi your agency and I would like o mee wih you for an inerview ha will ake abou one hour. The visi and he inerview can be done separaely or ogeher a a dae, ime, and place (for he inerview) convenien for you. All informaion you share will be confidenial. Wih your permission, I would like o ape record he inerview and ake noes. A a laer dae, I'd appreciae your review of a summary of your inerview and a summary of he group findings. Confirmaion Leer o Paricipan Dae Name Agency Address Dear Thank you for agreeing o paricipae in he sudy "Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program of Nursing". I look forward o visiing your agency on (Day, Dae) a (Time) and o meeing wih you on (Day, Dae) a (Time) a (agreed upon locaion). As we discussed, he inerview will ake abou 1 hour. Wih your permission, I will ape record he inerview and ake noes. A a laer dae, I'd appreciae your review of a summary of your inerview and a summary of he group findings. Please review he enclosed Consen Form prior o our appoinmen. I will be glad o answer any quesions you have before he inerview begins. One copy of he Consen Form is for your files. I highly value your responses o he inerview quesions and hope he informaion you share will help promoe successful parnerships a he Bolon School, your agency and oher schools of nursing and communiy organizaions. Sincerely yours, I Deborah Lindell MSN APRN, BC Suden, Nursing Docorae Program

183 174 Researchers CWRU IRB Applicaion Aachmen C CONSENT FORM Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program of Nursing You are being asked o be in a research sudy of your experiences as a communiy agency parner wih he Frances Payne Bolon School ofnursing, Case Wesern Reserve Universiy. You were seleced as a possible paricipan because you have parnered, or are currenly parnering, wih he faculy and sudens of he MSN Program, Frances Payne Bolon School of Nursing, Case Wesern Reserve Universiy. Please read his form and ask any quesions ha you may have before agreeing o be in he sudy. a Case Wesern Reserve Universiy are conducing his sudy. Background Informaion: The purpose of his sudy is o learn abou your organizaion's experiences and views as a parner wih he faculy and sudens ofmsn Program, Frances Payne Bolon School of Nursing, Case Wesern Reserve Universiy. Procedures: If you agree o be in he sudy, we would ask you o do he following hings: 1) Paricipae in an inerview in which you will be asked o describe he naure of your parnership; your views ofhe parnership (boh posiive and negaive); he effecs of he parnership on you, your agency, and your cliens; and your suggesions abou he parnership. 2) The inerview will ake abou 1 hour. 3) You will be asked for your permission o ape record he inerview. 4) The researcher may reques a follow-up inerview. 5) A a laer dae, you will be asked o review a summary of he findings. Risks and Benefis From Being in he Sudy: The sudy has he following risks: 1) You will be asked o ake abou 1 hour of your ime o paricipae in he inerview. 2) You will receive a summary ofhe inerview and will be asked if you wish o make any changes or addiions. 3) A a laer dae, you will be asked o review a summary of he group findings. 4) You will be asked o discuss boh posiive and negaive aspecs ofhe parnership. The benefis of paricipaion are: he informaion will be used o evaluae he parnership and may be used o improve he effeciveness of your parnership wih he Bolon School, oher Bolon School communiy-campus parnerships, and communiy parnership aciviies by oher schools of nursing. You will receive no reimbursemen for your ime... I Confidenialiy: The records of his sudy will be kep privae. In any sor of repor we migh publish, we will no include any informaion ha will make i possible o idenify you or your agency. Access o he records will be limied o he researchers; however, please noe ha sponsors, funding agencies,

184 regulaory agencies, and he Insiuional Review Board may review he research records. You will be asked for permission o audio ape record he inerview. These apes will also be kep in a locked file and will be desroyed a he compleion ofhe sudy. 175 ~ I I Volunary Naure ofbe Sudy: Your paricipaion is volunary. If you choose no o paricipae, i will no affec your curren or fuure relaions wih he Universiy. There is no penaly or loss of benefis for no paricipaing or for disconinuing your paricipaion. Provided o you will be any significan new findings ha develop during he course ofhe research ha may make you decide ha you wan o sop paricipaing. Conacs and Quesions: The researchers conducing his sudy are Theresa Sanding PhD, RN and Deborah Lindell MSN APRN,BC. You may ask any quesions you have now. If you have any quesions laer, you may conac Dr. Sanding a or Mrs. Lindell a If you would Iike o alk wih someone oher han he researchers abou: 1) concerns regarding he sudy, 2) research paricipan righs, 3) research-relaed injuries, or 4) oher human righs issues, please conac Case Wesern Reserve Universiy's Office ofresearch Adminisraion a or wrie: Case Wesern Reserve Universiy Office of Research Adminisraion 4 Adelber Hall Euclid Ave. Cleveland, OH You will be given a copy of bis form for your records. Saemen of Consen: I have read he above informaion. I have received answers o he quesions I have asked. 1 consen o paricipae in he research. I am a leas 18 years ofage. Prin Name of Paricipan: Signaure Signaure of Person Obaining Consen: I

185 176 I I I l- I I I I I I I I Paricipan's Name: Role a Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program of Nursing CWRU IRB Applicaion Aachmen D Paricipan Informaion Shee Organizaion Name: Address: Work Phone: Work Fax: Preferred Bolon School Course/s Paricipan Parnered Wih: 1. Semeser/year I 4. Semeser/year I I I I I I I I I Dae of inerview Agency code Paricipan code 9/02., rev. 12/02 DFL Lengh of inerview

186 177 Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program of Nursing CWRU IRB Applicaion Aachmen E Summary of he Research Inroducion: Academic-communiy healh parnerships (ACHP) are an effecive means for communiy healh organizaions (CHO) o enhance qualiy and quaniy of services hrough communiy capaciy building and for schools of nursing o provide opporuniies for communiybased educaion hrough service-learning. Successful parnerships should srive o mee esablished principles ha include: founded on a shared vision; clearly ariculaed values; and srong, reciprocal, collaboraive relaionships. Problem: Alhough he reciprocal, collaboraive naure of successful communiyacademic parnerships has been esablished, research has focused largely on he academic perspecive and he degree of rigor varies widely. Lile is known abou he perspecives of communiy agencies concerning such relaionships, paricularly parnerships involving graduae programs of nursing. Purpose: The purpose of he proposed research projec is o bridge he gap in service-learning research relaed o graduae nursing educaion and percepions of communiy parners by exploring communiy healh organizaions' views of parnership wih graduae programs of nursing educaion. The proposed research seeks o answer he following quesions: 1) How do CHOs describe he process of paricipaion in an ACHP wih a program of graduae nursing educaion? and 2) Wha facors do CHOs idenify as influencing parnership wih a program of graduae nursing educaion? Design: The design will use he grounded heory mehod of qualiaive research. The purpose of grounded heory research is o: search for, and seek o undersand and predic, social processes presen in human ineracion. The seing will be CHOs ha have parnered wih a graduae program of nursing from Sepember 2000 o presen, N= abou 15. The populaion will be key conac persons and oher saff members of each agency who have worked direcly wih he faculy and sudens of he Communiy Engagemen Through Service-Learning Projec (CETSL) of he MSN Program, Bolon School ofnursing, Case Wesern Reserve Universiy. The sample will be purposeful. Paricipans will be recruied unil all parner organizaions have had an opporuniy o paricipae and heoreical sauraion is achieved (See Aachmens A and B for more deails on recruimen). Daa collecion: The researcher will recrui he paricipans, visi each agency and conduc he inerviews. Paricipans will be asked o se a convenien day, dae, ime and locaion for he researcher o visi he agency and o conduc he inerview. Prior o he inerview dae, he informan will receive a leer of confirmaion (Aachmen B) wih a copy of he Consen Form (Aachmen C). Before he inerview begins, he inerviewer will answer any quesions, he informan will be asked o sign i he consen form and complee he Paricipan Informaion Form (see Aachmen D). The paricipan will be inerviewed in a semi-srucured, open-ended manner (see Aachmen F). The inerview will las abou 1 hour. In accordance wih grounded heory mehods of qualiaive research, he inerview quesions may be modified during he daa collecion process. Wih he paricipan's permission, he inerviewer will ape record he inerview and ake field noes during he ineracion. A a laer poin following he inerview, he paricipan will be asked o review a summary ofhe inerview and a summary ofhe group findings.

187 178 Daa Managemen: I) The ape recordings will be ranscribed verbaim as soon as possible following he inerview, 2) The ranscripions and he inerviewer's noes will be compared for accuracy and clariy, 3) The apes, inerview noes, informaion shees and ranscrips will be sored in a locked filing cabine wih access only o he co-invesigaor, D. Lindell, 4) All apes will be desroyed when he projec is compleed. Human Righs will be proeced per he procedures deailed in his documen. Daa Analysis: The researcher will analyze he ranscrips using grounded heory mehods as described by Glaser and Srauss (1967) and heir associaes. The seps, implemened simulaneously, will include: coding via a coding paradigm and consan comparison; memoing; soring; selecive coding based on he Basic Social Process; sauraion of codes, caegories, and consrucs; secondary lieraure review; and wriing he heory (Huchinson, 1993). Rigor: The rigor and rusworhiness ofqualiaive research are ensured when he design and he repor mee four crieria. I) A qualiaive sudy is credible when i presens such faihful descripions or inerpreaions of a human experience ha he people having ha experience would recognize i from hose descripions or inerpreaions as heir own. 2) A sudy mees he crierion offiingness when is findings can "fi" ino conexs ouside he sudy siuaion and when is audience views is findings as meaningful and applicable in erms of heir own experiences. 3) A qualiaive sudy is audiable when anoher researcher can clearly follow he "decision rail" used by he invesigaor in he sudy and could arrive a he same or comparable bu no conradicory conclusions given he researcher's daa, perspecive, and siuaion. 4) Confirmabiliy is achieved when credibiliy, fiingness, and audiabiliy are esablished (Sandelowski, 1986). The design and repor ofhe proposed sudy will incorporae several sraegies o ensure i mees he above noed crieria for rigor: 1) "brackeing" ofhe researchers previous experience and presupposiions abou he phenomenon so as o no allow hem o influence he daa analysis (via he researcher's journal); 2) assuring audiabiliy by "leaving a clear decision rial concerning he sudy concerning he sudy from beginning o end", review ofhe daa analysis process by a peer and 3) assuring credibiliy and fiingness by "checking for he represenaiveness of he daa; riangulaion of daa sources and collecion mehods; checking ha descripions, explanaions, or heories abou he daa conain he ypical and aypical elemens ofhe daa; deliberaely rying o discoun or disprove a conclusion drawn abou he daa; and obaining validaion from he paricipans" (See Aachmens G & H) (Sandelowski, 1986, pp ). References Glaser, B. & Srauss, A. (1967). The discovery ofgrounded heory: Sraegies for qualiaive research. Chicago: Aldine Publishing Company. Howard, J., Gelmon, S., & Giles, D. (2000) From yeserday o omorrow: Sraegic direcions for servicelearning research. Michigan Journal ofcommuniy Service Learning. Fall, 2000 (5-10). Huchinson, S. (1993). Grounded heory: The mehod. In P. L. Munhall & C. O. Boyd (Eds.), Nursing research: A qualiaive perspecive (pp ). New York: Naional League for Nursing Press. Sandelowski, M. (1986). The problem ofrigor in qualiaive research. Advances in Nursing Science 8(3),

188 CWRU IRB Applicaion Aachmen F Iniial Inerview Quesions Inroducion: I am ineresed in your views of your service-learning parnership(s) wih he faculy and sudens of he MSN program of he Bolon School of Nursing. Please make your responses o he quesions as open and hones as possible. As I'd like he informaion o focus on your houghs, I will hold any discussion unil he inerview has been compleed. To help ensure confidenialiy, please ry no o menion he name of your agency. If you've parnered wih more han one course, we can discuss hem separaely or combined, which ever you prefer. 1. Please ell me abou yourself and your role in his organizaion. a. Type of discipline b. How long employed a he agency 2. Please ell me briefly abou your organizaion - Purpose or Mission, Services, Cliens. 3. Please ell me abou your experience wih parnerships? a. If wih oher schools, wha disciplines? b. Wha ypes of aciviies were done? 4. Please ell me, from your own perspecive, abou he parnership projec(s) wih he Bolon School of Nursing MSN Program in which your organizaion paricipaed. If you have parnered wih more han one course, do you prefer o discuss hem separaely or ogeher? a. Wha was he purpose of he parnership? b. Wha was your role in he parnership? c. Wha was your orienaion like? To he MSN program? The course? Servicelearning? d. Wha ype of projecs did he sudens do? e. Describe your communicaion wih he faculy and sudens. 5. Tell me abou he oucomes of he projec(s) on your organizaion: a. Wha were your expecaions or goals? b. To wha exen were hey me and how? c. Wha wen paricularly well and why? d. Wha obsacles/barriers did you encouner and how did you deal wih hem? 6. Tell me abou he facors you see as imporan o success of parnerships such as yours wih he Bolon School ofnursing. a. Wha does i ake o have a successful parnership? b. By he faculy, sudens, and communiy agency? 7. Knowing wha you know now, wha could be done o improve he parnership? a. By you and/or your agency? b. By he Bolon School's MSN Program? 8. Is here anyhing else you would like o add? Thank you for your ime and responses o hese quesions. 9/02 rev. 12/02 l79

189 180 CWRU IRB Applicaion Aachmen G Pos-Inerview Leer #1 o Paricipans Dae Name of paricipan Agency Address Dear ' Sincerely Thank you again for aking he ime o speak wih me abou your perspecives of parnership wih he graduae nursing program of he Frances Payne Bolon School ofnursing. I is imporan ha I verify my findings wih he individuals who ake par in he sudy. Therefore, I am enclosing a summary ofyour inerview. I would appreciae i very much if you would read he summary and decide if i reflecs our discussion and wheher you would like o make any changes. Please wrie a noe on he summary and mail i back o me in he enclosed, samped envelope. When he sudy is finished, I will send you a summary ofhe group findings and will ask for your commens on hose as well. Be assured ha sric confidenialiy will coninue o be mainained in he sudy and any disseminaion ofhe findings. I look forward o receiving your reply soon. Please call me a (work) or (home) or me a dx141@po.cwru.edu wih any quesions or concerns. yours, Deborah Lindell MSN APRN,BC Suden, Nursing Docorae Program

190 181 CWRU IRB Applicaion Aachmen H Pos-Inerview Leer #2 o Paricipans Dae Name of paricipan Agency Address Dear Some ime ago, you were kind enough o le me alk wih you abou my sudy of communiy healh agencies' parnerships wih he graduae nursing program of he Frances Payne Bolon School of Nursing. I wan o hank you again for allowing me o learn abou your parnership experience. I am compleing he wrie up of my sudy and, as we discussed a he ime of he inerview, I have an addiional reques o make of you. I is imporan ha I verify my findings wih he individuals who ook par in he sudy. Therefore, I am enclosing a summary of how hose who ook par in he sudy described heir parnership experience wih he Bolon School of Nursing. I would appreciae i very much if you would read he summary and decide if you agree or disagree wih i. Please wrie a noe on he reply shee as o your houghs abou he summary and mail i back o me in he enclosed, samped envelope. When he sudy is finished, I will send you a brief repor of he findings. I wan o hank you again for aking par in he sudy. Be assured ha sric confidenialiy will coninue o be mainained in he sudy and any disseminaion of he findings. I look forward o receiving your reply soon. Please call me a (work) or (home) or me a dxi41@po.cwru.edu wih any quesions or concerns. Sincerely yours, Deborah Lindell MSN APRN,BC Suden, Nursing Docorae Program

191 DATE: TO: FROM: RE: CC: Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program Of Nursing June 3, 2003 CWRU Insiuional Review Board Deborah Lindell, Co-invesigaor (dxi41) Theresa Sanding, Responsible Invesigaor (ss2) IRB Proocol # Reques for Addendum Glenn Odenbre, Direcor, CWRU Office of Suden Communiy Service Daa collecion on he above referenced qualiaive research sudy is nearing compleion (N = 13). A mos, here will be 2 more inerviews. As per he original proocol and consen form, paricipans have been asked o review and commen upon a summary of heir inerview and will be asked o review and commen up a wrien summary of he overall findings ofhe sudy. We are requesing an addendum o he proocol as follows: 1) The paricipans will be invied o aend a focus-group ype meeing. 2) The meeing will be led by D. Lindell and G. Odenbre (Direcor, CWRU Office of Suden Communiy Service). 3) D. Lindell will presen, in an appropriae forma, he sudy findings. 4) Full confidenialiy of findings will be mainained. 5) Those who aend he group meeing will be asked o sign an updaed Consen Form (aached). The secions peraining o he group meeing are in bold. 6) Paricipans will be asked o reac o and commen upon he sudy findings. 7) Paricipans will be asked o give suggesions/sraegies as o how he CWRU Office of Suden Communiy Service can bes plan and implemen a fuure, larger program on service-learning and communiy-academic parnerships geared o a broader, more diverse range ofcommuniy organizaions. 8) The paricipans will be asked o permi he session o be ape recorded and noes recorded on flip chars. 9) Lunch and parking validaion will be provided hrough he funding noed below. No oher compensaion will be provided. Raionale: I) The co-invesigaor has received parial suppor for his sudy from he CWRU Office of Suden Communiy Service (OSCS) (Direcor, Glenn Odenbre). Mr. Odenbre is also a member ofhe co-invesigaor's Nursing Docorae hesis commiee and is familiar wih he sudy. 2) The Corporaion for Naional and Communiy Service (CNCS) is he original source of he OSCS funds. 3) Anoher aspec of he larger CNCS gran is he broader program referred o above (enaive dae: Fall, 2003). The CNCS is ineresed in receiving inpu from he arge organizaions as o how bes o plan he larger program. 4) Programs argeed oward a paricular populaion are more likely o be successful when he populaion paricipaes in he planning, implemenaion, and evaluaion of he program. Thank you for considering his reques for an addendum o proocol

192 I 183 I I I I I I I I I I I CONSENT FORM Communiy Healh Organizaions' Perspecives of Parnership Wih A Graduae Program of Nursing You are being asked o be in a research sudy ofyour experiences as a communiy agency parner wih he Frances Payne Bolon School ofnursing, Case Wesern Reserve Universiy. You were seleced as a possible paricipan because you have parnered, or are currenly parnering, wih he faculy and sudens of he MSN Program, Frances Payne Bolon School ofnursing, Case Wesern Reserve Universiy. Please read his form and ask any quesions ha you may have before agreeing o be in he sudy. Researchers a Case Wesern Reserve Universiy are conducing his sudy. Background Informaion: The purpose of his sudy is o learn abou your organizaion's experiences and views as a parner wih he faculy and sudens ofmsn Program, Frances Payne Bolon School ofnursing, Case Wesern Reserve Universiy. Procedures: Ifyou agree o be in he sudy, we would ask you o do he following hings: 6) Paricipae in an inerview in which you will be asked o describe he naure ofyour parnership; your views ofhe parnership (boh posiive and negaive); he effecs ofhe parnership on you, your agency, and your cliens; and your suggesions abou he parnership. 7) The inerview will ake abou 1 hour. 8) You will be asked for your permission o ape record he inerview. 9) The researcher may reques a follow-up inerview. 10) A a laer dae, you will be asked o review a summary ofhe findings. 11) You will also be asked o paricipae in a group meeing of he paricipans. 12) A he group meeing, you will hear a summary of he sudy findings and you will be asked o discuss/commen on hem. You will also be asked o make suggesions on planning of a program on communiy-academic parnerships and service-learning for a variey of communiy organizaions o be held a a fuure ime. 13) You will be asked for permission o ape record and make flip-char noes ofhe group meeing. Risks and Benefis From Being in he Sudy: The sudy has he following risks: 5) You will be asked o ake abou 1 hour ofyour ime o paricipae in he inerview. 6) You will receive a summary of he inerview and will be asked ifyou wish o make any changes or addiions. 7) A a laer dae, you will be asked o review a summary of he group findings. 8) You will be asked o discuss boh posiive and negaive aspecs ofhe parnership. The benefis of paricipaion are: he informaion will be used o evaluae he parnership and may be used o improve he effeciveness of your parnership wih he Bolon School, oher Bolon School communiy-campus parnerships, communiy parnership aciviies by oher schools of nursing, academic disciplines and communiy organizaions. You will receive no reimbursemen for your ime in he inerview.

193 A he group meeing, you will receive lunch and parking will be validaed. Confidenialiy: The records ofhis sudy will be kep privae. In he group meeing and any sor of repor we migh publish, we will no include any informaion ha will make i possible o idenify you or your agency. Access o he records will be limied o he researchers; however, please noe ha sponsors, funding agencies, regulaory agencies, and he Insiuional Review Board may review he research records. You will be asked for permission o audio ape record he inerview. These apes will also be kep in a locked file and will be desroyed a he compleion of he sudy. Volunary Naure of he Sudy: Your paricipaion is volunary. If you choose no o paricipae, i will no affec your curren or fuure relaions wih he Universiy. There is no penaly or loss of benefis for no paricipaing or for disconinuing your paricipaion. Provided o you will be any significan new findings ha develop during he course of he research ha may make you decide ha you wan o sop paricipaing. Conacs and Quesions: The researchers conducing his sudy are Theresa Sanding PhD, RN and Deborah Lindell MSN APRN,BC. You may ask any quesions you have now. If you have any quesions laer, you may conac Dr. Sanding a or Mrs. Lindell a If you would like o alk wih someone oher han he researchers abou: 1) concerns regarding he sudy, 2) research paricipan righs, 3) research-relaed injuries, or 4) oher human righs issues, please conac Case Wesern Reserve Universiy's Office of Research Adminisraion a or wrie: Case Wesern Reserve Universiy Office of Research Adminisraion 4 Adelber Hall Euclid Ave. Cleveland, OH You will be given a copy of his form for your records. Saemen of Consen: I have read he above informaion. I have received answers o he quesions I have asked. I consen o paricipae in he research. I am a leas 18 years of age. Prin Name of Paricipan: Signaure ofparicipan Signaure of Person Obaining Consen: 184

194 I 185 Appendix F Case Wesern Reserve Universiy Insiuional Review Board NOTICE OF APPROVAL Responsible Invesigaor: Theresa S. Sanding Deparmen: Nursing IRB Proocol # Tile: Communiy Healh Organizaions' Percepions of Parnership wih a Graduae Program of Nursing [Co-Invesigaor: Deborah Lindell] Approval Dae: Thursday, January 23, 2003 Coninuing Review Deadline: Thursday, January 08, 2004 Expiraion Dae: Thursday, January 22, 2004 The Insiuional Review Board (lrb) has APPROVED he above new proocol hrough he expedied review process. I has been deermined ha his sudy involves minimal risk, and ha no vulnerable populaions will be involved. As an invesigaor of human subjecs, your responsibiliies include he following: 1. Repor all adverse evens and unanicipaed problems involving human subjecs o he Office of Research Adminisraion (ORA) wihin hree (3) days of your knowledge of he occurrence. 2. Provide he ORA wih a complee Coninuing Review form (available a he CWRU IRB Web Pages, or from he ORA) by he coninuing review deadline noed above, and when he sudy is erminaed. 3. Disconinue all work peraining o his proocol if a coninuing review approval is no finalized by he expiraion dae noed above. 4. Submi all proposed changes o he proocol o he ORA, and receive approval from he IRB, before implemenaion ofhe change. 5. Keep all research daa and consen documens in your possession for a leas hree (3) years afer he compleion of he research aciviy. ****************************************************************************** *** CWRU Insiuional Review Board Euclid Ave. Cleveland, OH phone: fax:

195 I I Case Wesern Reserve Universiy Insiuional Review Board NOTICE OF ADDENDUM APPROVAL Responsible Invesigaor: Theresa S. Sanding Deparmen: Nursing - General IRB Proocol # Tile: Communiy Healh Organizaions' Percepions of Parnership wih a Graduae Program of Nursing [Co-Invesigaor: Deborah Lindell] Addendum Approval Dae: 6/5/2003 a The Insiuional Review Board (IRB) has APPROVED he submied addendum for he above proocol. As an invesigaor of human subjecs, your responsibiliies include he following: I. Repor all adverse evens involving human subjecs o he Office of Research Adminisraion (ORA) wihin hree (3) days of he occurrence. 2. Provide he ORA wih a complee Coninuing Review form before Thursday, January 08, 2004, and when he sudy is erminaed (Coninuing Review forms are available a he CWRU IRB web pages, or a he ORA). 3. Submi any furher changes o an approved proocol or consen form o he ORA, and receive approval from he IRB, before implemenaion of he change. 4. Keep all research daa and consen documens in your possession for a leas hree (3) years afer he compleion of he research aciviy. Commens: ****************************************************************************** *** CWRU Insiuional Review Board Euclid Ave. Cleveland, OH phone: fax: Please feel free o reply o his address, or o conac: Compliance Assisan Maureen Dore-Arshenoviz mxd4@po.cwru.edu or IRB Adminisraive Office (lao) Head Narinder Dhaliwal nkd3@po.cwru.edu or

196 Appendix G 187 Summary - Inerview Paricipan A (PA) 1. PA holds a leadership posiion in her volunary agency. PA has been wih he agency for 13 years. 2. PA has a numerous responsibiliies wihin he organizaion as well as professional roles a he local, sae and naionallevels. 3. PA is srongly commied o he mission of her agency and o providing holisic services her cliens.. 4. PA's organizaion is currenly facing decreased funding and she is seeking means by which she can mainain he work of he agency. This has involved new approaches o services. 5. PA values collaboraion wih oher organizaions. 6. PA sough he assisance ofhe School of Nursing (SON) in planning a major professional educaion program. 7. Afer speaking wih several persons a he SON, PA was referred o G. Narsavage wih whom she me o discuss her needs. 8. A faculy member oriened PA o service-learning and linked PA wih a parner faculy member. 9. PA spoke wih he faculy member by phone several imes and hey planned a projec for he Spring, 2001 semeser whereby sudens would assis in he planning of he professional seminar. 10. PA me wih he sudens a he SON wice and had on-going communicaion. 11. PA's role in he projec was o orien he sudens o he seminar and he healh problem and be available during he projec process o answer quesions. 12. I was no fel ha here would be added benefi for he sudens o come o PA's office. 13. PA was highly saisfied wih he parnership and found i o be a good experience. 14. The projec had posiive oucomes for PA: a. Sudens conribued (and PA learned) skills & knowledge needed o implemen he coninuing educaion credi componen ofhe seminar. b. PA learned abou a logic model relevan o he projec. IS. The sudens also benefied from he parnership: a. Sudens learned abou he specific healh problem addressed a he seminar and PA hopes hey will "spread he word" abou i and be aler for he problem in heir fuure pracice. b. Sudens learned abou he imporance of assessing program oucomes & how o develop an evaluaion for a professional educaion program. 16. PA would like o parner wih he SON again bu is unsure of how o inegrae he knowledge/skills ofhe sudens wih he work of her organizaion. 17. Parnerships need o be collaboraive - o mach organizaional needs wih he skills and knowledge ofhe nursing sudens. 18. PA has also been a member of he SON's CETSL Advisory Group a. PA's role has been somewha passive -as a lisener. b. PA is rying o idenify ideas for furher collaboraion. c. As a non-nurse, PA someimes feels like an ousider a he meeings mos members are nurses and have heir own language. d. A imes i seems like a nurses' club. e. There are few oher non-nurse communiy agency members. f. Feeling like an ousider does no keep PA from paricipaing. 19. There are many volunary organizaions in his area ha migh benefi from parnership wih he SON. 20. We need o brainsorm ideas for projecs - hink ou of he box o idenify ways o collaborae. Summary of Inerview Wih Paricipan B (P B) I) PB is a manager wih a large, naional non-profi organizaion. 2) PB has been wih he organizaion for 4112 years and is well-informed as o he operaions and services of he agency. I

197 188 3) PB has a number of roles and responsibiliies wihin he organizaion. 4) PB's work involves collaboraion wih oher agencies. 5) PB has been a member of he CETSL Advisory Group since is firs meeing and has worked wih several courses on a number of service-learning projecs. P2 learned abou service-learning from paricipaion on he advisory group. 6) PB' s career focus has moved owards communiy healh, communiy healh educaion, minoriy healh, and social services. 7) PB has a srong commimen o nursing and o supporing nursing educaion. 8) P Bbelieves in he service-learning process and makes i a prioriy. 9) PB saw he parnership as having several purposes: a) Provides opporuniies o fulfill he mission of he organizaion. The service-learning projecs give PB addiional resources and allow PB o move he work of he agency forward. b) Allows PB o implemen her personal and professional role o share wha she has learned and o help sudens link principles and heory learned in he classroom wih he work environmen. 10) PB has played several roles in her parnerships wih FPB faculy and sudens. a) Looks hroughou he agency o idenify possible projecs. b) Supervises he projecs direcly (majoriy of projecs) c) Suggess suden work direcly wih anoher saff member more closely involved wih he projec (liaison). II) PB described how she links sudens and projecs. a) PB idenifies possible projecs wihin he agency. b) PB communicaes wih he faculy member o undersand he focus of he course and he servicelearning objecives. c) PB visis he school of nursing o mee he sudens. P2 asks he sudens o refresh her as o he course name/number/focus. d) The sudens come o he agency for orienaion: i) An overview of he agency ii) Projec ideas e) PB mees wih individual sudens in an effor o mach suden ineress/characerisics wih projec needs. This makes he projec more ineresing for he suden and resuls in a beer projec. f) PB reviews he plans wih he insrucor. Are hey consisen wih he course objecives? g) PB gave several examples of how he maching process has worked. 12) PB believes communicaion is an imporan facor in he service-learning projecs. a) PB works closely wih he course insrucor. b) PB is up-fron abou communicaion i) All involved (PB, faculy and sudens) have busy schedules. ii) PB uses several mehods of communicaion: , phone, pager. c) A imeline helps everyone o know he plan and quickly see if hey are on rack. 13) PB has found he sudens o be high caliber, self-moivaed and follow hrough on projecs wihou close supervision. 14) PB described several facors in success of service-learning parnerships: a) The agency mus be commied o he service-learning process. b) Be realisic i) Find ou how much ime is alloed ii) Selec projecs ha fi in ha imeframe. PB has enough experience o know how long a paricular projec will ake. c) Be flexible d) The agency and faculy member mus have a close working relaionship. e) The agency mus undersand he focus of he class and he service-learning objecives. IS) PB recenly worked wih a faculy member who was new o service-learning and had some reservaions. a) PB ook he lead, alked wih he faculy member, gave examples of previous suden projecs, ried o help relieve some of he faculy member's concern. b) PB has no acually me he faculy member; hey keep missing each oher. 16) PB described he parnership as having posiive oucomes for sudens, agency and he paricipan.

198 189 I I I a) Sudens learn abou he agency and see heir projecs as par of a much larger picure. b) Sudens conribue o he work ofhe agency. PB gave several examples. c) PB has learned how nursing has progressed and has learned new conceps. d) The projec can be used o assess he need for, and barriers o, a larger projec. Sudens doing an assessmen projec sough inpu from he arge populaion. e) Allows insrucors in he agency's raining program o look beyond everyday classroom insrucion and idenify ways o enhance he program. PB keeps he ideas in mind for servicelearning projecs. f) PB described a number of projecs sudens have done and how hey enhanced he work of he organizaion. 17) PB has paricipaed in he CETSL Advisory Group a) PB has neworked wih oher members of he group. In one case, his has led o a whole new parnership. Anoher group member now speaks o he raining program and has he opporuniy o see poenial employees. b) PB works near he SON so can ge here easily. c) PB hosed a meeing of he CETSL group a he agency. d) PB fel he leader is sensiive o he variey of demands of group members. Meeings are scheduled convenien imes over lunch hour. e) The group meeings help o remind PB of SON schedules, class numbers and names. Inerview Summary -Paricipan C (PC) The Paricipan, Agency and Prior Experience Wih Parnerships The paricipan is a regisered nurse who works in a K-12 educaional seing. I The paricipan's responsibiliies are o provide comprehensive healh services. P3's roles include: adminisraion, policy developmen, classroom educaion, and implemenaion (direc care). I This is PC's 4h year in his school disric. PC has preceped sudens from oher schools of nursing -hese experiences were largely observaional, I clinical experiences. They did no involve a service piece. Overview of PC's Parnership Wih he Bolon School MSN Program 1. PC has worked wih one faculy member and course over hree years (2000, 200 I, 2002). The course is augh in he fall semeser. The firs service-learning aciviy wih CWRU sudens was as a pilo sie; here were hree projecs. During he las wo years, here have been 6 projecs each ime. 2. PC described he various projecs sudens have done and gave examples of how hey wen smoohly or had kinks. Several examples are noed in his summary. 3. Iniially, PC saw he relaionship as an opporuniy for CWRU sudens o have a learning experience in a communiy seing. 4. Over ime, he relaionship has evolved ino more symbioic, wo-way relaionship where here is some muual benefi. 5. The degree o which he relaionship is wo way may vary. The degree of muual benefi depends on I he exen of planning, degree of commimen by boh paries, ypes of suden projec, and i could be jus he day. 6. PC noed ha he school disric is very open o having sudens of all disciplines and having schools wih diverse culures makes he seing a good learning environmen. 7. PC does no really have o "sell" hese projecs o he principals and eachers. They view he projecs I as an opporuniy. a. Teachers are mos recepive o he nursing sudens when heir projecs correlae wih he curriculum and when he projec can be reused in place of a prepared classroom lesson. 8. PC has noed ha communiy parners see heir roles differenly. Some communiy parners are more concerned wih how he agency will benefi from he projec. 9. PC, as a eacher and nurse, saw he relaionship as "How can I enhance he sudens' learning experiences"? 10. PC has found ha orienaion and ongoing communicaion among agency, faculy and sudens are wo imporan facors in he parnership.

199 PC uses he erm "we" because she feels a "cool" hing of he parnership is ha he projecs belong no jus o he sudens bu are hers as well. 12. PC has learned ha some projecs such as muli-session programs were more involved han she originally hough. PC's Role in he Parnership 1. Choreographer or liaison, o cu hrough red ape wihin he agency so he sudens can implemen heir service aciviies. 2. Faciliae learning by he CWRU sudens. 3. Help sudens ha come in wih preconceived ideas of wha hey envision doing rehink heir ideas in erms ofhe needs of he agency and developmenal characerisics of he children. Orienaion 1. PC's iniial undersanding of he learning objecives of he course and ime line for he projecs was lacking and PC was no cerain how well he sudens undersood he service-learning as well. 2. In 200 1, PC wen o he nursing sudens' classroom, described her agency and her role. PC fel ha year sudens had a beer undersanding of he service-learning. 3. In 2002, PC did no visi he sudens' class and feels heir grasp of he aciviy was no as srong as in In 2002, PC's parner did orien he sudens as o he imporance of gearing heir projecs o he needs of he agency versus heir ineress. 5. PC believes sudens ha in order for sudens o have a successful service-learning experience, hey need o have a good, concepualized view of he dynamics of he agency and he planning involved in he suden's projec aciviies. 6. PC fel i would be beneficial for her o have an undersanding of wha is expeced of he sudens and wha heir imelines are. 7. PC and her faculy parner are alking abou ways o improve he orienaion componen of he parnership. 8. PC plans o develop a power poin presenaion o use in oriening he nursing sudens o her agency. Orienaion of he sudens o how he agency works, logisics and dynamics wihin he agency may help sudens selec an appropriae opic. Communicaion. 1. PC fel ha communicaion beween her and her faculy parner has improved as hey have goen o know each oher and he parner go o know he agency beer. Now he level of communicaion wih her parner faculy member is excellen. 2. Communicaion wih sudens can be a challenge especially when PC has 5-6 groups of sudens wih several sudens in each group (2001 & 2002). Things can ge harried when sudens change heir plans mid-sream. Suden plans and imelines need o be clearly defined. Thus, he purpose of he Proposal Shee. 3. is a very effecive means of communicaion. Paging seems o be less effecive. PC may be busy when she is paged. 4. The proposal shee is anoher form of communicaion. 5. The advisory group is anoher roue of communicaion beween PC & her parner. Planning and Implemenaion 1. PC has learned o negoiae he naure of he projec wih he sudens and define clearly wha he sudens plan o do. 2. PC developed a Proposal Shee as a ool for sudens documen hese plans and communicae wih her and he faculy member. 3. Areas o consider when arranging nursing suden projecs include: a. Paren permission - informed consen b. arranging muli-session projecs o coordinae absence of sudens from classrooms 4. PC looked for projecs ha will ouch sudens, parens, and saff by having longeviy of usage. 5. Try o use differen focal poins - i.e. for nuriion. All six projecs relaed o nuriion bu a differen age groups.

200 PC feels he parnership is opimized when sudens work in groups of2-3 versus 4-5. More classes can be ouched. 7. PC ries o link he sudens' ineress wih he insrucional level and curricular goals. Sudens ineresed in a paricular level or opic may have o shif heir plans. 8. PC noed ha suden projecs vary as o he amoun of ineracion wih he paricipans. Sudens seem o like he ineracion and feedback - i.e seeing he expression on a child's face. However, projecs where sudens do no have a direc wo-way communicaion can sill be very helpful (i.e. poser moved around o various schools). 9. Sudens need o commi o heir opic and imeframe early on. When sudens delay firming plans or change he opic or daes midsream, PC has o go back o he adminisraor and eacher and make necessary changes. The process can become very complicaed. 10. PC compared he process o peeling an onion -you keep peeling away layers unil you ge o where you need o go. Oher Thoughs 1. Anoher challenge involves coordinaing sudens' implemenaion daes. One year hey came wihin wo-week ime and his was difficul for PC o handle along wih her regular aciviies. 2. The course PC parners wih is augh in he fall PC's busies ime -sae repors and mandaed aciviies. 3. PC views he service-learning process as fun and enjoys he relaionship because boh he nursing sudens and classroom sudens are ouched as well as parens. 4. One ofhe bes benefis ofhe relaionship is ha i has affeced PC personally as o her professional growh. I forces her o look a her own pracice and role. I is a way o fulfill her professional responsibiliy o give back o her alma maer. 5. PC feels ha her agency is a perfec fi wih he course augh by her parner. 6. PC undersands ha he MSN sudens have complicaed lives oo and ha you are never going o please everyone. 7. The plans for one projec called for sudens o each on he same opic in wo culurally differen buildings. PC fel his was an excellen opporuniy for he sudens o learn o modify heir eaching o he arge group. Unforunaely, he sudens were slow o develop heir plans and one arge group had o be removed. This ook away from he poenial learning value ofhe projec for he sudens. PC was disappoined. 8. PC feels a check and balance sysem would help o opimize he learning experience for sudens and service o he agency -i.e. make sudens allow enough ime in planning he projec o presen i o her before he acual classroom or for her o review maerials o make sure hey are appropriae. 9. The bes group in Fall 2002 was one ha go an early sar & was well planned and organized. 10. PC mees wih her faculy parner a he end of he semeser o review heir aciviies. 1). PC and her parner are hinking ofdeveloping a brief checklis for feedback and percepions from eachers when here isn' an opporuniy for eacher reflecion. PC believes his is imporan. 12. PC can see a difference beween working wih BSN and MSN sudens. MSN sudens are more comforable wih heir nursing pracice, more confiden in heir nursing skills, and draw on heir life experiences. PC likened i o a se ofnesing dolls- anoher layer for sudens o use. 13. PC's advice o an agency new o service-learning: jump righ in, give i a chance - you will be surprised a how he agency benefis, wha he sudens learn and how hey maybe develop heir own eaching philosophy and use i as a ool. PC and he CETSL Advisory Group 1. PC has found paricipaing in he advisory group o be a posiive experience. 2. A way o give back o her alma maer. 3. A means of neworking anoher member ofhe group has been a resource o her several imes. 4. PC learns rends in nursing educaion 5. PC feels conneced o he school ofnursing. 6. The meeings are held a a convenien ime (lunch) and are shor and o he poin. 7. PC likes o hear how oher agencies are uilizing service-learning. I simulaes PC o hink ofnew ways o work wih sudens.