IMPACT of a Service-Learning Project on Nursing Students

By Bentley, Regina; Ellison, Kathy Jo

ABSTRACT

This article describes the incorporation of a service-learning project in a maternal-infant health course in a baccalaureate nursing program. Partnership goals between university faculty and project Early Head Start were to develop and implement a clinical education experience that not only enhanced services to teenage mothers, but also taught students key elements in the delivery of community services to this vulnerable population. This article examines the impact of the service-learning experience on students’ understanding of diversity, perceptions of social responsibility in community service, and health care issues. Implications for faculty investment of time and resources are also explored.

Key Words Service-Learning * Adolescent Pregnancy * Social Responsibility * Health Promotion * Reflective Thinking

Hands-on educational experiences for nursing students that impart an appreciation for service are ranked by professional educators as highly important (1,2). Providing such experiences is a challenge that is too often left to chance.

* Service-learning combines service and learning in intentional ways. It differs fundamentally from volunteer activities, community service, internships, field education, and traditional clinical experiences. These are not less important than service-learning, but the approaches, objectives, and outcomes have a different focus. Bringle and Hatcher define service-learning as a “course-based, credit-bearing educational experience in which students (a) participate in an organized service activity that meets identified community needs and (b) reflect on the service activity in such a way as to gain further understanding of course content, a broader appreciation of the discipline, and an enhanced sense of civic responsibility” (3, p. 112). * Structured opportunities that link service to self-reflection, self-discovery, and the acquisition and comprehension of values, skills, and knowledge content are critical to service-learning. As they learn more about community assessment and community resources, students come to understand how their interest m nursing can be developed in the surrounding community (4- 6) and they benefit from a powerful learning experience.

Helping Teens Transition to Parenthood A partnership with project Early Head Start and a grant from the Auburn University School of Nursing led to a service-learning opportunity to address the needs of pregnant teenagers and help them transition from pregnancy to parenthood. Twenty nursing students who were enrolled in a course on childbearing were selected through computerized random sampling for the project. The remaining 38 students in the class completed the traditional student assignments such as attending an antenatal clinical and choosing their own clients in order to complete the antenatal and family assessment requirement. All students had completed courses on health promotion and health assessment the previous semester.

The students in the service-learning project and their clients met six to eight times during the 10-week summer semester for one- on-one teaching and encouragement. All of the nursing students were white, and one was male. The teenagers were all African Americans of a low socioeconomic level. On occasion, the teenagers’ parents were present.

Table. Service-Learning Strategies

The students attended selected prenatal clinic visits, ultrasound visits, and visited the teenagers in their homes. One student was also able to be present at the birth. Service-learning activities did not replace clinical time spent in hospitals but did replace the time students would have spent at an antenatal clinic.

Every other week, Early Head Start hosted a health promotion program and lunch for the students and their clients. The students provided programs on topics such as sexually transmitted diseases, substance abuse prevention, family planning, nutrition and exercise for the mother, and newborn care. Videos were purchased, and the students gave the teens a booklet on newborn care that they had written and designed. Extra copies were made for the Early Head Start program. The students also gave their clients gift bags with personal items and infant supplies selected after an assessment of each teenager’s individual needs.

To promote reflective thinking, students met each week after class to reflect on their visits with the teens and explore issues of concern. Students were also required to write in a journal after each visit and develop a portfolio that included all teaching topics, copies of resource materials used, family and antenatal assessments, and journal entries with dates of visits. Faculty provided feedback during discussions and in writing. The Table includes examples of strategies and activities used to stimulate reflection related to course objectives.

Project Evaluation A survey provided by Health Professions Schools in Service to the Nation, Community-Campus Partnerships for Health (7), was used to evaluate the project. Sixteen students agreed that community participation showed them how material learned in class could be used while working in the community and that participating in the community helped them understand the lectures and reading better. Comments included:

* “It made me learn the material so that I could teach it to my teenage patient.”

* “It made me responsible in being prepared for the meetings with the patient so that I could appear confident in my knowledge.”

* “We were able to do a lot of education with the project and by talking about the class subject topics it helped me to better understand some of the material.”

In their end-of-program portfolios, students indicated that learning to apply the course material was one of the most meaningful aspects of the experience.

A goal for this project was that the students would increase their commitment to community service. Only five of the students volunteered in the community prior to the service-learning program. After the project, 19 students said that they have a responsibility to serve the community and 18 said that they were more aware of the needs in the community where the teens lived. As they interacted with teens and became aware of the difficulties they faced, they learned how social responsibility relates to professional practice. Typical comments included:

* “It made me more aware of the community needs and the resources that are provided.”

* “I liked doing something for the community.”

* “This project allowed me to provide a service to the community and both sides benefited from it.”

Eighteen students said that the project helped them become more aware of the problems faced by the population with which they worked. One student said: “I also gained a better understanding of low-income families and how hard it must be,” and another stated, “I learned a lot about working with people who do not appreciate the services provided and how hard it is to get in touch with clients.”

Their comments show that these students were gaining a different perspective than they had in the past. Some were frustrated because clients did not seem to “appreciate” what they were trying to do for them and often seemed “uninterested.” In discussions, students reflected on the different perspectives patients have on health care and on the attitudes of their clients about their own health and what it takes to have a healthy baby. They considered whether the teenagers lacked the desire to be healthy or felt invincible and assumed they would remain healthy despite their behavior. Journaling helped the service-learning group process and recognize their impact on others.

As Boss found (8), the service-learning experience not only improved sensitivity to moral issues, but helped students recognize and overcome the negative stereotypes that act as barriers to interacting with others. They began to appreciate the differences in their clients’ life situations as compared with their own and gained an awareness of the types of circumstances that affect health and well-being. Assuming the roles of teacher, change agent, and advocate, they learned to respect the dignity of their clients and experienced the need to be flexible in their willingness to serve. These results fit well with the goal that students would increase their understanding of the lives of people from disadvantaged cultural and socioeconomic groups.

Of the 20 participants, 18 indicated that they became more comfortable working with people different from themselves and that this project enhanced their ability to communicate their ideas within a real-world context. Fifteen students stated that service- learning made them more aware of some of their own biases and prejudices. Nineteen believed that they could make a difference in the community. Learning the needs and desires of individual teens and helping to fulfill them through education, counseling, and a personalized gift was a transformational experience that helped motivate the students to be more enthusiastic about nursing in general and mother/infant nursing in particular.

A final goal of this project was to improve learning of the course material. Data indicated that the students thought the service-learning helped the\m learn the material for the class. Even though data analysis at a .05 alpha level did not demonstrate a statistically significant difference in the grades of the service- learning group, it did show that they scored higher on Test I (service-learning group, M = 83.43; others, M = 81.99); the final exam (service-learning group, M = 84.72; others, M = 83.00); and the comprehensive Health Education Systems (HESI) maternity specialty exam given at the end of the course (service-learning group, M = 92.01; others, M = 90.22). The national average for the HESI maternity exam is 87.6 percent (A. Nibert, personal communication, April 15, 2004). Both groups of students exceeded this average.

Evaluation of the teenage clients’ attitudes was conducted through the use of a survey provided to the clients by a social worker assigned through Early Head Start. The completed surveys were returned to the school of nursing. Results indicated that the teenagers were very satisfied with the experience. They stated that the information provided by the students had been helpful, that the students had been helpful in locating information and services, and that they would allow nursing students to assist them in the future. They also reported that the aspect of the experience that they liked best involved interacting with the nursing students.

The Importance of Faculty Involvement Enthusiastic faculty who can attract community partners are essential for successful service- learning (6). Even though students are not directly supervised, students must be given feedback in weekly face-to-face meetings with faculty. Those in charge of the experience should read the students’ journals, manage the reflection sessions, and interact with community agencies (9). This style of involvement allows for experiences to be interpreted in a meaningful and realistic manner and is critical to integrating the experience with course objectives.

Some faculty members find the time commitment for service- learning to be burdensome. For this project, 20 students, out of a total group of 58, were selected to allow sufficient time for appropriate faculty participation. Meeting with the students, reading their weekly journals, and attending the educational sessions they provided was time consuming but worthwhile.

According to Zlotkowkski (10), faculty who state that it is important to link service with education may lack the commitment to participate. Harrington (9) recommends linking service-learning activities to the research and teaching interests of faculty as an excellent way to generate enthusiasm and maximize students’ outcomes from the experience. Depending on university policies, the integration of service and the faculty member’s teaching and research roles may be beneficial for meeting promotion and tenure requirements. Coordination of the tripartite role of faculty can serve as a stimulus for integrating this form of pedagogy into a faculty member’s teaching methods.

Another plus is the visibility and the connections that service- learning creates for the school in the community. Service-learning experiences help nursing faculty meet the challenge to provide more community-based education, a mandate for nursing in the 21st century (11,12). As Hamner and colleagues emphasize (13), an engaged university unites teaching, research, and service functions to become more sympathetically and productively involved in its community.

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About the Authors Regina Bentley, EdD, RN, is an assistant professor, and Kathy Jo Ellison, DSN, RN, is an associate professor, Auburn University School of Nursing, Auburn, Alabama. Auburn University provided the funding for this study.

Copyright National League for Nursing, Inc. Sep/Oct 2005