Journal of Nursing Education

Theoretical Foundations of Service-Learning in Nursing Education

Patricia A Bailey, EdD, RN, CS; Dona Rinaldi Carpenter, EdD, RN, CS; Patricia Harrington, EdD, RN



Although somewhat new to nursing, service-learning has had a long history of development. To be successful, a service-learning program must have institutional support, interested faculty and motivated students, potential for strong community partnerships, and an ongoing orientation and development component. Reflection is an important link between the service students perform and the learning outcomes of that service.



Although somewhat new to nursing, service-learning has had a long history of development. To be successful, a service-learning program must have institutional support, interested faculty and motivated students, potential for strong community partnerships, and an ongoing orientation and development component. Reflection is an important link between the service students perform and the learning outcomes of that service.

Experiential learning. Critical thinking. Community service. Civic and personal responsibility. These concepts express notions central to the servicelearning experience. As a teaching approach, servicelearning, or service applied to professional nursing, can provide a unique way to expand on traditional ways of knowing within the discipline. This article provides an overview of the historical development of service-learning, defines the concept and places it within a meaningful context for nurse educators, explores essentials for success, and describes the importance of reflection for an effective service-learning experience.


The historical evolution of service-learning can be traced back to nearly a century ago. Dewey (1916) was one of the earliest proponents of this particular educational pedagogy. From the early 1900s, educators recognized the importance of connecting service to educational goals. During the past century, the concept has evolved to what it is currently- a teaching pedagogy that connects service to academia in a reciprocal educational relationship.

Over time, the idea of connecting service to education expanded. More structured service-learning programs emerged in the 1960s and early 1970s as a result of student community activism. Couto (1982) noted that, "During the student activism of the late sixties, those demanding relevance in education urged student participation in social and political changes and not merely an examination of social and political issues from afar" (p. 1). Students wanted to understand the politics and culture of the time from a theoretical perspective, as well as through living the experience.

By the late 1970s and early 1980s community service programs were losing momentum. It seemed as though the concept had run its course and service-learning was quickly becoming an idea of the past. Programs that attempted to continue did not receive the necessary institutional support. Lack of an essential connection between service and academia, along with a reduction in budgets and funding programs for service, contributed to the demise of many service-learning programs.

As the end of the 1980s approached, there was a renewed interest in service to the community and promoting civic responsibility. Soon, faculty, students, and administrators were looking toward the development of curricular models that supported service-learning. According to Mintz and Liu (1994), "Passage of the National Community Service Act of 1990 resulted in hundreds of federally funded service-learning programs across the country" (p. 11). Then, "on September 21st, 1993 President Clinton signed into law the landmark national service bill establishing an unprecedented mandate to tackle the nation's pressing challenges through community service" (Pew Health Professions Commission, Bureau of Health Professions, U.S. Public Health Service, & Corporation for National and Community Service, 1994, p. 5). With this renewed enthusiasm, it also became clear that if service-learning programs were to be established successfully, educators would need to pay attention to the past. The components that differentiate service-learning from other types of experiential learning emerged from the factors that contributed to past failures. The lessons learned would need to be applied to new service-learning programs and included (Mintz & Liu, 1994):

* The community must be a partner in defining its needs.

* An education component integrated with the service activity is necessary to foster student learning and enhance the quality of service.

* Service-learning programs must be aligned into the everyday life of the institution to be sustained.


Serrice-learning essentially describes a structured, reciprocal learning experience that combines and connects the service experience to academic coursework with reflection opportunities. According to Bailey, Carpenter, and Harrington (1999), "Some of the beliefs that are held regarding service-learning are at least partially accurate; others can be problematic to the success of a new program" (p. 5). Jacoby (1996) further emphasized that service-learning is embraced in different ways by higher education. Regardless of mission, service-learning must include four cardinal components:

* Be experiential in nature.

* Allow students to engage in activities that address human and community needs via structured opportunities for learning.

* Incorporate reflection.

* Embrace the concept of reciprocity between the service-learning and the person being served.

The concept of reciprocal learning is essential and differentiates the experience from traditional service experiences. Learning must flow from service activities in such a way that the individuals who are engaged in a service activity and those who are the recipients of service are learning from the experience. Service-learning can enhance the community focus of the nursing curriculum. However, these service-learning experiences differ from the traditional community clinical experience because the focus is on both the studente and the recipients of care. Traditional learning can be enriched by the service experience. Critical thinking skills can be enhanced as students learn to be reflective practitioners and develop a renewed sense of civic responsibility.


Institutional Support

Critical to the success of any service-learning program is the support of the institution, administration, faculty, and students. Commitment to serving the community should be reflected in the institution's mission and supported by the president and other administrators. The budget for an effective program includes funding for support staff who would:

* Coordinate service placements.

* Arrange for agency orientation of students.

* Maintain records related to student hours and transcript credits.

* Serve as liaisons to the community agencies served.

Because faculty play a pivotal role in making servicelearning meaningful, providing funds for them to attend national and regional conferences demonstrates institutional support. Institutions can develop student leaders in the service-learning arena by offering incentives, similar to those offered to faculty, for students to attend conferences and share their service-learning experiences with others. With strong institutional support, an effective service-learning program can be sustained.

Faculty Interest

Encouraging faculty to select service activities for students that they themselves are engaged in can increase faculty's interest in service-learning. Driscoll (2000) raised concerns about a lack of research related to faculty satisfaction with service-learning and found, anecdotally, that faculty who incorporated service-learning into their courses reported they were able to fulfill their personal goals of serving the community. Holland (2000) suggested that service-learning must be linked to the institution's recognition in the academic arena in the same way research currently is recognized. Without the guarantee that participation in service-learning will be valued and recognized for tenure and promotion, faculty are less likely to participate. At the authors' university, several nursing faculty engaged students in their own service projects, including hospice, HIV outreach, and intergenerational activities. Several projects received grant support that led to faculty-student presentations at national conferences. Given the opportunity to participate in service-learning, most faculty appreciate the effect on students and find that experiences in the community do provide the "teachable moments" they value in the classroom. Zlotkowski (1996) stressed that faculty participation is the most significant variable for a successful service-learning program.

Community Partnerships

The community-campus partnership must be a winwin relationship. The needs of the students and the community group served share equal importance. Essential to service-learning is the focus on helping the community partner address an unmet community need through the service-learning collaboration with the university. The literature is replete with examples (Kulewicz, 2001; Maurana & Goldenberg, 1996; Simoni & McKinney, 1998; White, 1999). These authors, emphasize the need to adhere to Sigmon's (1979) principles. Especially critical is that the community being served controls the service provided (Sigmon, 1979).

Bailey et al. (1999) described aspects of program development that support partnerships. Central to their success was the establishment of a community advisory committee, whose members contributed to the development and evaluation of the program. Nurturing the partnership is a key responsibility of the university, and placing students who are interested in the community partner's work is important. Maurana and Goldenberg (1996) captured the essence of successful community-campus partnerships in their essential principles for success- leadership, partnership, and empowerment.

Student Motivation

Providing service-learning experiences in the first nursing course is an effective way to establish student motivation because the service experience is related to classroom learning through written and verbal reflection. By allowing students to select a service project, rather than assigning them to one, their motivation is strengthened. Providing students with a challenging service experience that is connected to what they are learning in class and is important to the community group served will increase their motivation and overall satisfaction with the experience (Peterson & Schaffer, 1999). An important objective of service-learning is for students to internalize their commitment to serving others, and many students will complete more than the required number of hours and will even continue their service commitments after the course has ended.

Development and Orientation Programs

After a service-learning program is established, ongoing development and orientation for faculty, students, and community partners is needed. Institutional support must include resources for faculty to develop and maintain skills that will ensure the program's success. Attending national conferences and on-campus workshops are ways to enhance faculty expertise. Resources for sustaining service-learning programs are numerous, with several notable sources to choose from, including:

* Community-Campus Partnerships for Health (CCPH) (http ://www.futurehealth. ucsf. edu).

* Campus Compact (

* The National Service-Learning Clearinghouse (

Information sessions and end-of-year luncheons with community partners provide opportunities for sharing the pros and cons of the service experience from the perspective of all (i.e., students, community partners, faculty) and serve as a formal mechanism for evaluation.


Evaluation of the service-learning program is needed to improve the experience for campus and community partners, and both are important in this process. Students evaluate their service experiences through journal writing and reflection sessions and in end-of-course evaluations. Meaningful feedback from faculty guides students during the experience and, together with group reflection sessions, allows them to incorporate their service experiences with real-world issues in nursing.

While it may be challenging to include the community partners in service-learning evaluation, it is critical thenfeedback be obtained. Creative and flexible scheduling of evaluation sessions makes inclusion easier. For example, a "focus group" luncheon including representatives from the community and the university (i.e., faculty, students, administrators) could be held. Quantitative instruments completed beforehand can bolster qualitative data collected from the focus groups and after the service experience is completed. Evaluation is critical to the success of the service-learning program.


The Link Between Service and Learning As the literature clearly indicates, reflection positively affects student learning outcomes (Eyler & Giles, 1999; Logsdon & Ford, 1998; Simoni & McKinney, 1998). It is essential that students critically reñect on their service experiences if they are to connect what they see and do in the community with what is occurring in the academic setting. Coles (1993) cited reflection as key to an effective service experience:

Our institutions of higher learning might certainly take heed, not only by encouraging students to do such service, but by helping them etop and mull over, through books and discussions, what they have heard and seen. This is the purpose, after all, of colleges and universities - to help one generation after another grow intellectually and morally through study and the eelf-scrutiny such study can sometimes prompt (p. 148).

One needs to keep in mind the essentials for a successful reflection experience- creatmg/clarifying meaning of the experience, flunking, critically analyzing, and connecting community with learning. While reflection may not be entirely new to students, they will need an orientation to the process and an explanation of the importance of reflection in the service-learning experience.

Options for Reflection

The most common form of reflection for students is journal writing. By actually putting one's thoughts into words and on paper a more in-depth reflection likely will occur. Various forms of journal writing include personal journals, dialogue journals, and shared group journals. For all types, a general outline for journal writing should be provided to students. A personal journal may or may not be shared with faculty but would be a student's own reflection of the service experience. In contrast, a dialogue journal is shared with the faculty teaching the course. In some cases, it may be a community partner who responds to the student by way of the journal. An effective method is to use e-mail or another computer program for sharing the journal. The faculty member or community partner reads the journal and responds to the student, sharing and commenting on the reflection. Shared group journals work well when all students are engaged in the same community experience.

Classroom discussion is an effective way to encourage reflection on the service experience. This can occur throughout the semester either at specified times or as issues come up related to the service and topics being covered in class. A few questions to guide the discussion are helpful, but it is also important to allow for freedom of ideas and issues for all to reflect on. This method often will help disclose expectations and myths students share about the service experience. Social analysis of community needs and the importance of civic responsibility are often themes that emerge during group discussions.

Organizing a focus group has proven to be a successful method for reflection. These groups can include community partners, in addition to students and faculty. A set of questions to guide discussion and a reporter to record are helpful during this process. Not all faculty may be comfortable leading a focus group, so it is essential that experienced group leaders are involved in this method of reflection.

Other creative ways to reflect are to use audiovisual presentations and creative fine arts to help students in the process. Students may author their own presentations or may select various media to demonstrate their creative thinking about the service-learning experience. Some may be comfortable with presenting a dance or engaging in role play. Some students welcome the opportunity to exhibit their creative nature, and this encourages others to creatively reflect on their service experience. Other methods for reflection include use of portfolios, shared readings, and reaction papers. This is not an exhaustive list of reflection methods, and faculty must decide what method is best for their course, their students, and a particular service-learning experience.


Faculty are in a unique position to incorporate servicelearning experiences into the nursing curriculum. In doing so they are expanding community-based experiences for students and establishing strong, meaningful community partnerships. A clear understanding of the theoretical foundations of service-learning and of the essentials for a successful program will help faculty as they expand their teaching styles to include service-learning experiences.


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