I think Julie has lice. Can you help us?” “Nancy isn’t acting right. She seems ‘off.’ She’s not relating to me like she usually does.” “Suzie gets up in the middle of the night, shouting and rambling and waking up all the guests.” These shared concerns expressed in the voices of volunteer staff are urgent and numerous and reflect their needs for care of the homeless, yet such concerns are seldom addressed in the literature.
The above scenarios voiced by the volunteer staff of a local homeless shelter provided an opportunity to integrate service learning into an undergraduate nursing research course in an innovative manner. The undergraduate nursing research course, offered in the senior year, contains a 3-hour didactic component and an 8-hour clinical component per week. The course faculty work with cooperating agencies and the local community to determine whether there is a need for data collection and analysis in their respective areas. Projects are identified and reviewed for their appropriateness and feasibility for undergraduate students. Once approved, students volunteer for the projects based on their area of interest. Students work on a project in small collaborative groups over the course of the semester.
The clinical project serves as the glue that holds the course together. Student groups identify a clinical question based on the project and critically review the literature, perform critical appraisals of supporting research, write an integrative review of the literature, and participate in data collection and analysis. The course culminates in a public scientific presentation. Students earn grades for each of the written requirements, as well as for the scientific presentation of their clinical project.
Course faculty serve as overall research mentors for student groups, and each group has a contact person in the organization to assist in navigating the clinical or community setting. During the spring 2012 semester, there were a total of nine projects. Students worked in groups of three on their designated projects. This article describes the experiences of one collaborative group whose community-based service learning project took them down roads not previously traveled.
Our school is a small, private liberal arts college with the primary mission of teaching, embedded within a framework of service to the local and global community. In 2012, the college initiated an innovative program designed to promote an in-depth examination of complex issues that challenge humanity. The thematic focus for the 2011–2012 academic year was poverty and inequality. Departments, courses, organizations, and clubs were encouraged to incorporate these themes into their respective programs or courses.
Nursing faculty involved in teaching the undergraduate research course believed a community project using a service-learning approach could be developed within the framework of poverty and inequality. Several local churches provide food and shelter for the homeless population from December through March. Designed as a ministry, church volunteers staff the shelters and provide an evening meal and a morning meal for the sheltered individuals. Homelessness is a complex socioeconomic phenomenon, yet there is a paucity of literature pertaining to the education of staff or volunteers who provide care for this vulnerable population. Shelter volunteers expressed the need for more education on dealing with crises, specific mental health disorders, and communication strategies for such circumstances.
Given the emphasis on poverty and inequality, coupled with the needs of volunteers working in the sheltering ministry, a service-learning approach appeared to be a natural fit with this clinical project. Academic service-learning is characterized by relevant and meaningful service with the community, purposeful civic learning, and enhanced academic learning (Howard, 2001). For this project, student immersion with the homeless population included a regular pattern of participation in serving meals, engaging in conversation with sheltered individuals, and assessing the educational needs of the volunteer staff. Civic learning occurred as students built relationships with the sheltered individuals who represented diverse backgrounds and multicultural groups. Reflective discussion with students about what they were experiencing, combined with analyzing literature on the causes for homelessness and related social problems, cultivated a desire in students to work for social change.
The project proposal received exempt status from the college institutional review board on the basis of the educational nature of the project. Three undergraduate nursing students expressed an interest in working with the homeless population. The students completed a comprehensive review of the literature, examining multiple aspects of homelessness and the needs of the volunteers who serve the population. Immersion experiences at a soup kitchen and the ministry’s other sheltering locations allowed students to gain awareness of the world of the homeless population and to meet and interact with sheltered individuals and the volunteers who provided guidance and supervision at the shelters. The project focused on developing an evidence-based educational intervention for volunteers, targeted specifically toward awareness of cues to violent or disruptive behavior and communication strategies for such circumstances. The students used a quasi-experimental, one-group, after-only design for their project. They used a convenience sample from shelters where affiliations had been established.
The undergraduate nursing students formulated learning objectives for the educational intervention of volunteer staff. Flyers and e-mail announcements were distributed to all of the ministry’s shelters and the soup kitchen, inviting all volunteers to attend an educational program titled “Mental Health First Aid and Communication Skills for Care of Sheltered Individuals.” The students presented a 45-minute interactive program consisting of basic communication strategies, video clips of communication vignettes, situations of escalating violence, and strategies for early recognition and intervention based on current research. Interventions for other special situations included suicidal individuals and alcohol or substance intoxication and withdrawal. The educational session was offered in a small group setting with an open discussion format, which encouraged volunteers to share particular concerns and questions related to communication with the sheltered individuals. Attendees were requested to complete a student-constructed survey evaluating several aspects of the educational program. A clinical expert in psychiatric–mental health nursing (P.A.), who was also one of the faculty in the research course, accompanied students during their sheltering experiences and mentored them in the education program development. Two faculty experts reviewed the survey to establish content validity. The clinical expert also attended the volunteer education session and helped facilitate the discussion portion of the presentation.
This innovative approach to teaching an undergraduate nursing research course met several student learning outcomes, including analysis of research as a basis for practice, application of research principles to the project with the homeless population, and understanding the nurse’s role in research as an opportunity for practice change. The service-learning project with homeless individuals gave students the opportunity to follow the steps of designing a research project. They generated a clinical practice question: “How can nurses meet the educational needs of volunteers for the safe assessment and handling of sheltered individuals in a homeless shelter?” Other specific outcomes of the research process (design, data collection, and analysis) were met through project execution. Formal presentations to professional nurses and interdisciplinary faculty met a specific learning outcome for dissemination of the findings. Perhaps most important, students recognized the contribution of their research findings for the care of the homeless population. Their implications for nursing practice included early assessment of homelessness, appropriate planning with community resources, and nurses’ participation in volunteer care of the homeless. For nursing education, they recommended that homelessness and mental health issues could be addressed simultaneously through undergraduate clinical experiences within the shelters.
As part of understanding the research process, the students were also encouraged to identify strengths and limitations of their project, whether in process, in design, or both. Students identified timing issues as a limitation, noting that their project began half-way through the sheltering season (December through March); volunteers stated the education program would be more beneficial at the beginning of the season. In terms of the design, students suggested that a pretest–posttest design would have evaluated the knowledge and needs of the volunteers with more specificity. Sampling was also identified as a limitation, with access only to selected shelters within the community, perhaps presenting a bias and also rendering a small sample size. Strengths of the project were the authentic engagements forged in the community, not only with shelter volunteers but also with homeless individuals. Additional strengths identified by the students were the enhancement of their psychiatric–mental health knowledge base and their opportunity to practice and apply therapeutic communication skills. On the basis of this outcome, an experience in the soup kitchen has been added to the mental health course practicum.
Student evaluations of this innovative approach to nursing research provided data that support their achievement of learning outcomes. In response to the prompt “Indicate at least one learning outcome you have achieved,” one student commented:
I learned the importance of research and the benefits it can have to a person’s education and the nursing profession as a whole. I also became much more comfortable presenting such a formal topic in front of a large group of people.
Several students shared the broad impact of their learning on their future nursing care practice. One student commented:
It has challenged me in that I am now wondering if I would like to one day do nursing research. I feel more inclined to use evidence-based nursing in my practice now.
Similarly, another student commented:
I have learned to appreciate nursing research more as a result of this course. I have also become more aware of what the research is saying versus what is actually being done in practice. I hope to continue educating myself and making positive evidence based changes in my workplace if necessary.
The depth and diversity of learning by students traveling the road of community-based service-learning encompassed much more than achievement of the research course outcomes. Personal discoveries, such as recognition of biases and attitudes, were voiced, as one student commented, “I have learned to be more humble.” Students also shared with faculty and each other new insights gained about their responsibility as nurse citizens who can and must address issues of the vulnerable homeless population. During the educational session, volunteers aired common concerns and questions about particular individuals in the shelter and their behaviors. Students were often unsettled by the complexity of the problems they witnessed and those for which the volunteers sought guidance. The following vignette illustrates one such situation, which required compassionate understanding, yet firm limits and behavior expectations:
One sheltered individual smeared fecal matter in the bathroom on several occasions. Volunteers were challenged with meeting the physical needs of this individual, setting limits on inappropriate behavior, recognizing the fragile nature of her psyche, and responding in kind, while also maintaining safety of all personnel. Guided by their mental health nursing faculty expert, students were able to suggest options for handling difficult behavior, setting priorities, and supporting basic positive skills, such as building trust and maintaining a safe environment.
Foundational to providing compassionate and patient-centered care to diverse populations, nursing education must include knowledge and sensitivity in the area of culture, socioeconomic background, and health disparities (American Association of Colleges of Nursing, 2008). As a pedagogy, service-learning has been particularly useful in providing opportunities for nursing students to serve vulnerable populations. In their review of the literature on service-learning with vulnerable populations, Gillis and Mac Lellan (2010) identified that a major benefit of service-learning was its ability to foster a sense of civic responsibility in students. Groh, Stallwood, and Daniels (2011) found that senior nursing students who participated in service-learning opportunities with vulnerable groups experienced higher scores in leadership skills and social justice than prior to this experience. In our course, we found that students assumed ownership over their project and were deeply committed to serving this population by being responsive to the educational needs identified by the volunteers. They were fully engaged in the research process, which became more meaningful through their involvement in the sheltering ministry. Using a service-learning approach to teach undergraduate research and evidence-based practice, Balakas and Sparks (2010) reported that students found the experience of working with a community partner to be more meaningful as a learning experience.
Teaching research to Millennial undergraduate nursing students using experiential learning promoted their engagement in the process. Typically, Millennial learners work well in collaborative environments and value doing rather than knowing (Mangold, 2007). For example, the students eagerly participated in the activities of the soup kitchen and the church shelters to establish relationships with the sheltered individuals and volunteers. By being digital natives, they were comfortable developing short vignettes in the form of video clips that were incorporated into their presentation (McCurry & Martins, 2010).
Although the educational session was well-received, it merely scratched the surface of addressing the multifaceted needs of those who provide care in homeless shelters. However, it is vital to recognize the impact of beginning the steps in the education process, the reciprocity felt by shelter volunteers, and the promise of establishing an ongoing partnership in the community. At a later date, when education resource guidebooks were distributed to the coordinators of the sheltering ministry, the following feedback was provided: “The training program the students ran was a tremendous help. During our meeting last night, a couple of the coordinators referenced things they learned at that training” (L. Mixon, personal communication, April 12, 2012).
Partnerships formed with the community provide rich and meaningful opportunities for students to learn concepts of research while serving in the real world. Faculty expertise in the selected project area (e.g., mental health) is desirable for successful implementation of the community-based service-learning pedagogy in the nursing research course. This is particularly essential where the community partner does not have a health care professional with whom the students can connect. In this project, ongoing faculty presence and engagement with students and staff in the community was necessary to facilitate interventions for homeless individuals with mental health issues. Although this approach was labor intensive for faculty, student learning outcomes surpassed the traditional expectations for an undergraduate research course. Students demonstrated a great respect for the research process, grew in their leadership skills, developed greater insight into social and health problems of vulnerable groups, and exhibited advocacy. These students also forged new territory for future groups of students who will be working with the homeless population and those who minister to them. In the words of one student, “These people are just like you and I…. I would not have truly realized that had it not been for this experience.”
- American Association of Colleges of Nursing. (2008). The essentials of baccalaureate education for professional nursing practice. Retrieved from http://www.aacn.nche.edu/education-resources/baccessentials08.pdf
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