As we move further into the 21st century, nurse educators and nurses are witnessing the development of more diverse health care settings, increased health care needs, and more complex nursing practice. In response to the multifaceted changes in health care, the National League for Nursing Educational Competencies for Graduates of Associate Degree Nursing Programs (Coxwell & Gillerman, 2000) updated the expected competencies of associate degree nursing program graduates. Professional behaviors, communication and assessment skills, caring interventions, teaching and learning, collaboration, and managing care are defined, and outcome competencies are identified for each.
Through evaluation of a service-learning project at Kapi'olani Community College, faculty recognized service-learning aa a means to enhance the ability of its graduates to meet these competencies. This article provides an overview of the service-learning project, presents the goals of the project and of faculty, student, and community agency participation, and discusses project evaluation, including outcomes and challenges. Recommendations for service-learning project development are included.
The nursing program at Kapi'olani Community College began using servicelearning as a teaching method in 1996. More recently, service-learning became a campus "cross-curricular initiative, which serves to integrate course content, infuse skills, and provide cohesive learning contexts" (Shimabukura, 2001, p. 8). Furco (1996) distinguished service-learning from other methods of experiential education, noting that service-learning focuses equally on both service and learning and is mutually beneficial for the provider and recipient of the service. Using this definition, faculty began to offer service-learning options in psychiatric, maternal-child, and LPN-to-RN transition nursing classes. In the fall of 1999, faculty added service-learning as a teaching method to the course requirements for the Adult Health Nursing III course.
Adult Health Nursing III is the final semester medical-surgical nursing course for associate degree nursing students at Kapi'olani Community College. It is a 5credit class in which lecture equals 2 credits and clinical experiences equal 3 credits. The clinical component includes clinical laboratory experiences and acute care hospital-based experiences. In 1996, faculty identified a lack of community-based health care experiences in this curriculum and a growing need for graduates to be exposed to non-acute care settings. Adding service-learning to the final semester course provided students an opportunity to participate in community activities, be responsible and accountable for their learning, and manage care of thente of all ages in various health care settings. In addition to these course outcomes, servicelearning provided an opportunity for students to meet several campus competencies of understanding and appreciating diverse cultures, understanding self, communication in society, the dynamics of change or human experience.
In 1999, the nursing program and the American Red Cross Hawaii State Chapter developed a partnership in the Community-Campus Partnerships for Health's Partners in Caring and Community program, a service-learning in nursing education program supported by the Helene FuId Health Trust. The two main goals of this partnership were to:
* Incorporate service-learning into this final semester medical-aurgical nursing course.
* Develop and sustain a partnership, which allowed students to become certified American Red Cross HTV/AIDS peer educators so they could provide services for that organization.
During the development of this partnership, faculty learned that not all students were interested in HIV/AIDS prevention education, and success would be dependent on students' enthusiasm. Therefore, to meet students' learning needs and interests, faculty organized a diverse selection of service-learning projects that allowed students to select one of interest. Projects included health fairs; gerontology programs; campus health clinic work; outpatient education programs; clinic work with uninsured and homeless people; shelter work with homeless, pregnant, or abused individuals; senior centers; and nursing homes, as well as the American Red Cross HTV/AIDS peer educator option. The service-learning content of this course continued to include these diverse options.
Planning and Implementation
Faculty set up service-learning sites; developed requirements, course objectives, and grading criteria; and facilitated and monitored students' reflection and learning. They helped students select an agency, establish a partnership with the site supervisor, and make the connection to course objectives. Faculty organized training sessions for specific agencies or projects to facilitate the process. They also monitored the hours of service, consent to work with the agencies, and agency feedback.
Community agencies are selected from a campus list of available service-learning sites and through partnerships established by faculty. The agencies and students identified community and agency needs. For example, the American Red Cross Hawaii State Chapter staff helped identify the needs of their agency and the community. The role of the community partner evolved into directing the students in meeting community needs. For the community leader (i.e., an HIV/AIDS instructor with a nursing background, leadership ability, and expertise in peer education, who volunteered to join the project), this included training students and facilitating their presentations. For example, when community groups requested HIV/AIDS education, the community leader connected students with that agency and helped them organize, implement, and evaluate the presentation. The community leaders, known as site supervisors on the Kapi'olani Community College campus, provide students with agency-specific training related to their policies and the clients they serve. Students worked individually with the site supervisors in developing their goals of the service and meeting the agency's expectations.
Students identified a service that fit their personal needs or goals, provided the service, and reflected on its connection to the course objectives, while identifying their own learning. The student leader (i.e., a student with high academic standing, leadership skills, experience with HIV/AIDS, and enthusiasm for servicelearning, who volunteered to join the project) at Kapi'olani Community College facilitated the development of a servicelearning requirement that met more students' interests, encouraged peers to be open to the service-learning options, and promoted the benefits of service-learning. The student leader also facilitated communication between faculty and students and provided feedback that allowed for adjustments. Faculty made successful adjustments to meet students' time constraints and personal interests.
Faculty facilitated individual and group reflection each semester. Bailey, Carpenter, and Harrington (1999) considered reflection a possible way to develop critical thinking skills in nursing students. Individual students reflected in journals and included what they anticipated, a description of the service they provided, and their goals. Students described the significance of the service, what they learned, and how they met the course objectives. They also reflected on the effect of this service on their lifelong learning, the connection to their personal or career goals, and the connection to nursing, health care, and society.
Group reflection, facilitated by faculty, consisted of two sessions each semester with the entire class. Students individually reflected on the needs of their community, the different roles of RNs in this community, the course concepts applied in this community, and the positive outcomes of this experience. Students shared these reflections in small and large group discussions. The service-learning requirement for this course consisted of 20 hours of service, three reflection journals, and two group reflection sessions. The course objectives connected to the service-learning project include application of the nursing process, especially evaluation and modification of care; client and family teaching; acting as a member of the health care team; and managing client care.
During the past 3 years, faculty expanded the service-learning requirement to allow students to select a community agency of interest. With the American Red Cross Hawaii State Chapter, Kapi'olani Community College certified more than 20 prenursing and nursing students as American Red Cross HIV/AIDS peer educators. Some of these peer educators conducted presentations to area elementary school, high school, and community college classes. Others disseminated HTV prevention information to a group of community college microbiology students interested in becoming peer educators.
HIV/AIDS peer educators conducted presentations in outlying rural communities, downtown health centers, and nonprofit family treatment centers. A group of 9 peer educators gathered their resources and conducted presentations for more than 60 new practical nursing students on World's AIDS Day. Two students developed and produced a video connecting drug and alcohol use with the spread of HIV and sexually transmitted diseases among young people. Two other students developed an educational brochure about the relationships among drugs, alcohol, sex, and HIV/AIDS. Each peer educator played an integral role in HIV prevention education during World's AIDS Day activities and National Sexual Responsibility Week activities. These peer educators provided more than 25 community education sessions to more than 300 participants.
At other service-learning sites, students provided diverse services to various community groups and individuals. Students completed health and physical assessments at clinics, provided immunizations, and implemented direct client and family teaching, as well as group health promotion education. Students facilitated group sessions at homeless shelters, teen pregnancy programs, alcohol and drug rehabilitation programs, and nursing homes. Students developed, implemented, and evaluated these health promotion and disease prevention sessions in collaboration with the site supervisors.
Factors that facilitated these achievements included funding of materials for training and presentations, commitment and enthusiasm from all partners, and open rapport between partners. Flexibility from faculty, students, community leaders, and agency staff, along with persistence and continued community needs, sustain this service-learning project at Kapi'olani Community College. The communication that began with the original partnership and developed during the Community-Campus Partnerships for Health's Partners in Caring and Community leadership retreat kept faculty focused and encouraged continuation of the project. The individuai team members' work ethic, interest, and flexibility allowed faculty to expand and accomplish more than they anticipated.
This service-learning project has been assessed both internally and externally. The community groups evaluated the American Red Cross HTV/AIDS peer educators, and these evaluations have been excellent. During campus activities and health fairs related to the project, students conducted evaluations with the participants attending and assessed the feedback. In addition, site supervisors completed anonymous evaluations of students' performance at the end of the semester. The campus service-learning office collected these evaluations and reported receiving positive feedback from every agency.
The students evaluated the servicelearning goals and project in a formal evaluation at the end of the semester. Ninety-eight percent of the students agreed the service-learning component of this course improved their understanding of self and their place in the world; their understanding of and appreciation for diverse cultures, societies, and human experiences; and the need for lifelong learning. Ninety percent of the students agreed this experience-based teaching method allowed them to meet course objectives related to therapeutic communication, teaching in nursing, self-development, and community service.
Faculty compared student responses from a 1996 survey with responses collected in 2000 and 2001. Faculty found more students in 2000 and 2001 believed they had sufficient community-based experience in the nursing program at Kapi'olani Community College than in 1996. Students in 2000 and 2001 also reported more diverse types of community-based experiences. Based on the community agencies' and etudents' responses, faculty continued this service-learning teaching method.
Evidence in the students' journals indicated the value of this service experience goes beyond meeting course and program objectives. Some of the words etudents used to describe this experience-based learning included challenging, rewarding, confidence building, motivating, educational, enriching, fulfilling, and exciting. Students shared the following reflections on their service-learning experiences:
* I learned a lot about other people, about myself, and about my values and beliefs and the needs of our community.
* I can't say enough about how I enjoyed volunteering here.
* I feel great when I go home from this place because I realize that today I made a difference in somebody's life.
* We bad to work with different cultural backgrounds and people that have different views.
* Throughout my entire service-learning experience, I learned so much about the gift of teaching and providing someone with the ammunition to take control of a disease.
* [This experience! also allowed me to feel more comfortable and gain confidence in my ability to teach.
* 1 learned that 1 should not be afraid of tackling hard projects. I found it uplifting.
Some students who participated in these projects indicated they plan to continue their service. The students reported they developed many leadership, teaching, and communication skills that will be useful in their careers. Some community agencies and students have notified faculty that students plan to continue to provide service after graduation.
Challenges and Lessons Learned
Challenges encountered by faculty include time constraints, lack of funding, students' commitments to work and family, and students', faculty's, and community leaders' heavy workloads. FlexibUity and commitment from all partners eased the effect of these challenges. Community agencies struggled with orienting new etudents each semester and lack of students during summer break In an attempt to increase student service, faculty encouraged students to remain at the same agency.
In this program, students may begin service-learning while taking prerequisite courses. When enrolled in the program, students have the opportunity to continue this service in some nursing courses. This is feasible if the service or agency provides opportunities for students to meet specific course objectives. The benefit for the community agency is having experienced students return. Decreased diversity in community-based health care experiences would be a disadvantage for students and a concern for faculty. Faculty are considering implementing a community-based service-learning program that is not attached to a specific course, but rather is a component of the nursing program that continues throughout an individual student's education. Faculty continue to discuss how much time is appropriate for servicelearning experience-based education in this program.
Lessons learned included knowing students' needs and preferences and developing a long-range plan to sustain a community-agency partnership. Getting to know the community partner and working together to develop a service-learning project that meets an identified community need and course objectives, without adding work, is challenging but feasible. The author also recommends that anyone involved in service-learning should reward students, community leaders, and faculty.
- Bailey, P., Carpenter, D.R., & Harrington, P.A. (Eds.). (1999). Integrating community service into nursing education: A guide to servicelearning. New York: Springer.
- Coxwell, G" & Gillermaa, H. (Ede,). <2000). National League for Nursing educational competencies for graduates of associate degree nursing programs. Sudbury, MA & New York: Jones and Bartlett and National League for Nursing.
- Furco, A. (1996). Service-learning: A balanced approach to experiential education. In Expanding boundaries: Service and learning (pp. 2-5). Washington, DC: Corporation for National Service.
- Shimabukura, J. (Ed.). (2001). Kapi'olani Community College University of Hawaii general catalog 2001-2002. Honolulu. HI: Kapi'olani Community College.