A child born prematurely breathes with the assistance of a ventilator. An elderly man requires a feeding tube after a stroke.

Once, they might have been cared for in a hospital. Today, they are apt to be at home, in school or in a specialized day program--but still requiring assistance from nurses trained in skilled care.

The College is addressing the need through new courses in community-based care, developed with a grant from the Helene Fuld Health Trust in New York. The courses, a didactic class and a clinical experience for seniors, aim to prepare new graduates for jobs with community agencies.

"People are discharged quicker and sicker" today, says Linda Bucher, associate professor of nursing, who wrote the curriculum for the courses. For example, she says, children, often preemies who just a few years ago would not have lived very long, may rely on high-tech equipment for survival. Adults who have experienced major illness are likely to be discharged from the hospital in less stable condition than in the past. Nurses with community agencies care for people with nutritional problems, asthma, cystic fibrosis, Prader-Willi Syndrome, heart or lung ailments, seizure disorders and other serious ailments. Patients may need oxygen therapy, feeding tubes, intravenous therapy or mechanical ventilation.

The College's nursing curriculum committee had those trends in mind in late 1998, when Erlinda Wheeler, assistant professor and committee chairperson, spotted a request from the Fuld Trust for proposals relating to curriculum and faculty development in community care.

"We were really looking to increase community experience for students at that time," Wheeler says. Their first proposal to the Fuld Trust was turned down, but Wheeler persisted. Bucher, experienced in both critical care and community care, agreed to help modify the application. In spring 2000, they won a grant for $66,212, permitting Bucher to be released temporarily from her teaching responsibilities to design the courses.

Home-care agencies in Delaware and nearby areas have responded enthusiastically, the professors say. "This is a big change from five to 10 years ago," Bucher says, noting that agencies used to hire only experienced nurses.

"With the nursing shortage, you have to hire new grads," says Bridget Adams, director of nursing at Nurses 'N Kids, the agency where some of the CHNS students are doing their clinical work. Nurses 'N Kids, which offers prescribed pediatric extended care and home services, and other agencies now sometimes hire new graduates and precept them on the job, Adams says.

Bucher traveled on home visits with agency nurses to learn more about the range of cases they handle. She and Wheeler provided agency staff a full-day continuing education program that prepared these nurses to function as preceptors for the students.

Ten students took the courses for the first time in spring 2001. For most of them, as for most of the 10 students taking the clinical course this semester, community nursing was not their first career choice.

"This is the first time in our curriculum that they had an in-depth experience with home-care nursing," Bucher says. "I think it rather overwhelmed them." The College's new nursing curriculum, which went into effect with the Class of 2004, includes a course in community care that will give students more background and hands-on exposure before their last semester of senior year, Bucher says.

Christie (Lindaberry) Celli, HNS 2001, was one student who knew firsthand about the specialty before signing up for Bucher's courses last year. "I've had family members who've been involved in hospice and home care before," she says, adding that she loved her clinical experience at the Christiana Care Visiting Nurse Association (VNA). "It really gave me a sense of independence in what I was doing, which you can't get in the hospital."

Gail Wade, assistant professor of nursing, who is teaching the clinical this semester while Bucher is on sabbatical, says the course is evolving from the original focus on home-based critical care. This year's title is "Community-Based Pediatric Acute Care," reflecting the available clinical opportunities: the Day Medicine Unit at Alfred I. duPont Hospital for Children, Bayada Nurses, Nurses 'N Kids, the Smart Start program for high-risk maternity patients at Christiana Care VNA and the John G. Leach School for students with disabilities. Though most community-care patients are not critically unstable, Wade says, they do require a high level of skilled nursing care.

Elizabeth Lantieri, HNS 2002, signed up for this year's course. "Being in people's homes and the community seemed more active than being in a hospital," she says.

"I worked in home health care for a little while. You get to talk to families more. It's a good way to have a personal relationship with your patients," says Bonnie Paulson, HNS 2002, a former certified nursing assistant for Nurses 'N Kids. "You have time to address issues families are concerned about."

"I want to work in a hospital, [but] I think this type of experience makes you a well-rounded nurse," classmate Heather Bieler, HNS 2002, says.

--Sandy Dennison-James