Connecting the Dots: Learning Through Real-World Scenarios - January 2020

Throughputs in Action: Orientation/Onboarding

Connecting the Dots: Learning Through Real-World Scenarios

Submitted by Susan Haynes Little, DNP, RN, PHNA-NC, CPHQ, CPH, CPM

Kristen Briggs, MSN, RN, NCSN

North Carolina Division of Public Health, Raleigh, NC

Lori Rhew, MA

North Carolina Institute for Public Health, Chapel Hill, NC

One of the joys of working in professional development is seeing the light bulbs glow brighter as participants connect the dots with new concepts and apply their freshly-obtained knowledge and skills. The opportunity to witness this connection up close occurred after a recent revision to a session in a state-required course for non-baccalaureate prepared nurses practicing in local public health departments. The course, Principles and Practices of Public Health Nursing, is required during the first year of employment and augments the local agency’s orientation to the specialized public health nursing (PHN) role (American Public Health Association, 2013). The course provides exposure to concepts not consistently provided in associate degree nursing programs and covers foundational information integrating core PHN functions through the synthesis of nursing, public health, and social sciences. 

A key course session that addresses how to develop PHN interventions was recently revised to increase learner engagement, knowledge retention, and competency-building. The session covers the importance of addressing vulnerable populations, social and non-medical determinates of health (SDOH) (Hsieh & Coates, 2017), individual-level social needs (Castrucci & Aurbach, 2019), and the three levels of prevention (Stanhope & Lancaster, 2016) during patient encounters. This information was historically provided in a lecture format. However, in response to the growing need to address factors that impact health beyond traditional healthcare interventions, it became a priority to revise this session.

The authors of the course worked with PHN specialists from the state’s Division of Public Health to develop real-world scenarios reflecting health issues PHNs typically address in their practice. These include environmental health, child health, school health, women’s health, mental health, communicable disease, and sexually transmitted disease diagnosis and treatment. The revised format reflects contemporary issues in nursing and learner engagement, learner interaction, and provides participants the necessary tools to control their learning.

Here is how the revised session unfolds: participants engage in a short, interactive session on SDOH, individual-level social needs, and the three levels of prevention that are taught through lecture and large group discussion. The course instructor then reviews a case scenario with the participants and facilitates a group discussion about the scenario. Next, the participants break into small groups and work on scenarios reflecting PHN work with different sub-specialties and client groups. A typical scenario worksheet (see Figure 1) describes a complex public health client situation. This small group work allows course participants to apply the knowledge gained throughout the course to the practice scenario.  

practice scenario.png

After participants complete the scenarios and document their findings, each small group reports to the large group. When more than one small group is assigned to the same scenario, the instructor facilitates a discussion exploring different ways to manage the same scenario. Participants report that the session enhances their learning due to the opportunity to expand ideas and to hear thoughts from other participants. Participants’ comments also affirm the session helps connect the dots and tie everything together. They agree that having the content presented in an interactive way made it easier to understand.

Nurses working in most healthcare settings must address the importance of SDOH and individual-level social needs on health. We encourage you to use our scenario worksheets to create interactive sessions that fit your specialty practice and educational setting. Once the light comes on, it continues to shine bright. 


American Public Health Association, Public Health Nursing Section (2013). The definition and practice of public health nursing: A statement of the public health nursing section. American Public Health Association.

Castrucci, B., & Aurbach, J. (2019, January 16). Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog.

Hsieh, D., & Coates, W. (2017). Poverty simulation: An experiential learning tool for teaching social determinants of health. AEM Education and Training, 2(1), 51-54. doi:10.1002/aet2.10076

Stanhope, M., & Lancaster, J. (2016).  Public health nursing: Population-centered health care in the community. Elsevier.





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