Fostering collaboration between academic and community settings is critical to meet the future needs of health care (Institute of Medicine, 2010). Community–academic partnerships (CAPs) are often initiated to support educational objectives and clinical practice within nursing programs (De Geest et al., 2013; Sadeghnezhad, Heshmati-Nabavi, Najafi, Kareshki, & Esmaily, 2018). Service-learning has been identified as a component of CAPs to support nursing student development (Ezeonwu, Berkowitz, & Vlasses, 2014; Voss, Mathews, Fossen, Scott, & Shaefer, 2015). Benefits of service-learning partnerships have included a greater awareness of community strengths and needs, improved competencies in caring for diverse populations, and multidisciplinary teamwork (Taylor & Leffers, 2016).
Factors contributing to successful CAPs include trust, effective communication, and shared mission and/or goals (Drahota et al., 2016). In contrast, excessive time commitments and lack of financial resources have been associated with hindering partnerships (De Geest et al., 2013). Mutual benefit has been cited as a critical element for success (Bay & Tschanen, 2017; Hunter & Botchwey, 2017; Mayer, Braband, & Killen, 2017). Yet, less than 4% of CAPs identify mutual benefit as a factor contributing to the collaborative process (Drahota et al., 2016).
Hunter and Botchwey (2017) described a mutually beneficial partnership between a university and elementary school focused on an interdependent civic engagement project. Their partnership was unique in that it provided an opportunity for both populations of students to engage in service. Although these types of creative partnerships offer new opportunities for dual learning, investigating benefits of CAPs is critical to their development and sustainability (De Geest et al., 2013; Drahota et al., 2016).
Voss et al. (2015) proposed a service-learning framework for measuring benefits specific to CAPs. The four key elements of the framework—feasibility, access, data collection, and consistency—were used to design this study to optimize identification of partnership benefits. The purpose of this study was to identify the benefits of an innovative CAP between a college of nursing and an elementary school aimed to engage both nursing and elementary school students in service-learning.
A service-learning project originated through a partnership between a southern university college of nursing and an elementary school. The community partner was a K–5 elementary school located in a rural county serving over 500 students. The partnership was initiated by the lead author, who cotaught an international community health nursing course involving a 3-week cultural immersion in Guatemala. The course included community service projects in which nursing students provided charlas (health talks) to children on topics such as hand washing and dental hygiene. After several years of offering the course, the faculty recognized a need for resources to support the charlas. Consequently, faculty reached out to a local school to create a collaborative service-learning project between second grade students/teachers and nursing students/faculty. The project aimed to collect supplies (e.g., soap, toothbrushes, toothpaste) that were used to facilitate the charlas. The partnership was sustained for 4 years.
Case study methodology offers a mode of inquiry to examine unique cases and are often used to answer how questions to employ explanatory functions (Yin, 2014). In this single-case study, the inquiry was to identify how partners benefit from a CAP within the context of service-learning. Purposive sampling resulted in 10 participants who agreed to participate, including two nursing faculty, two nursing students, four elementary school teachers, and two administrators, resulting in equal representation from the community partner and the college. After institutional review board approval, informed consent was obtained from the participants. Pseudonyms were used to ensure confidentiality.
Data were collected retrospectively from 2013 to 2017 and prospectively in 2017 to 2018. Data were triangulated from four sources of evidence—interviews, physical artifacts, documents, and fieldwork—to enhance rigor and credibility (Yin, 2014). Semistructured interviews lasting approximately 30 to 45 minutes were audiotaped. Interview questions included:
- What do you think the benefits of this partnership have been?
- How has service supported student learning experiences?
Physical artifacts (e.g., photographs, newspaper clippings) and documents (e.g., project meeting notes) were collected. Fieldwork included participant observation and collection of data pertaining to the elementary school and university settings, social context, and partnership activities. Strategies to establish trustworthiness included triangulation of multiple data sources, prolonged engagement of primary investigator in partnership, consultation with an outside researcher to minimize bias, and by members checking the findings (Shenton, 2004).
Inductive content analysis guided the process of coding, identification of categories, and abstraction of data (Elo & Kyngäs, 2008). Initially, interviews were transcribed verbatim into a Microsoft© Word document and memos were used to codify topics. Transcripts were analyzed by three reviewers separately, then collaboratively. First- and second-cycle coding (i.e., holistic and pattern) were used to construct a coding scheme (Saldaña, 2016). Variances in coding were discussed until consensus was attained. Interview data were then triangulated with additional data sources. Following iterative discussions, the researchers identified three generic categories representing student (microlevel), curriculum (mesolevel), and partner (macrolevel) benefits. Descriptions of the multilevel benefits were confirmed by each participant. Abstraction of the data continued to identify three main categories: (a) student service leadership development, (b) service-learning curricula enrichment, and (c) enhanced partner service initiatives.
Student Service Leadership Development
At the microlevel, student benefits were described in the area of service leadership development. Throughout the partnership, nursing students engaged in activities with the community partner building on their service leadership capacity. These activities included annual student-led lectures covering topics on the geography and culture of Guatemala, aspects of daily living for rural Guatemalan children, and principles of service-learning. These lectures aimed to equip the second graders with the knowledge they needed to implement a service-learning project within their school. A nursing graduate described the empowerment she felt working with the community partner:
It really solidifies when you're actually doing the service itself…it is just empowering to give back to communities.
For the second graders, service leadership was fostered through the implementation of a school-wide initiative to collect charla supplies for Guatemala. The students used creative strategies to inform other students, teachers, and parents about the initiative. Specifically, strategies such as classroom presentations and weekly announcements on the school's news network were used to engage other grade levels in service. A participant noted how the school-wide initiative reinforced values of service leadership in the students:
[The initiative] was the perfect opportunity for them to step out and say, “It is not about me, it is about other people.” [They] understand how when you help others it helps you…to build that part of being a citizen.
Service-Learning Curricula Enrichment
Enrichment of both the nursing study broad and primary education curricula were noted as mesolevel benefits. Specifically, the partnership enriched the college of nursing's study abroad program by supporting student service in Guatemala. Prior to the partnership, charla supplies were limited as they were dependent on what nursing students could purchase. However, over the span of the 4-year partnership, more than 6,000 charla items were collected to support health education in rural Guatemalan schools. Emma, a faculty member, explained how these donations provided nursing students with additional resources to facilitate their community service projects in Guatemala:
I think the benefit of both the [education] and the resources go hand-in-hand…the toothbrushes and the toothpaste, you know those are small items, but they go a long way in resource-poor countries.
Curricula benefits for the elementary school included enhancement in areas to meet requirements of the Public Schools of North Carolina (2010) essential standards for second grade social studies. In particular, service-learning activities supported the standards pertaining to learning global awareness and citizenship. One of the participants elaborated on how the project helped his students to make connections between culture and language:
One of the most important [connections] is the cultural awareness of students…. They start opening their minds about what's happening around the world.
Enhanced Partner Service Initiatives
Enhanced service initiatives were macrolevel benefits described by both partners. For the university and the college of nursing, the partnership supported both their mission and strategic goals. Specifically, the partnership supported the university's mission “to serve” and the college's global initiatives in Guatemala. One faculty member brought attention to the value of philanthropy within both the nursing profession and the college and how service-learning supports this value:
Philanthropy is giving of yourself, giving of your time…so when you foster service-learning with our students…the student learns about a community, and learns about the importance [of service].
The partnership also supported the elementary school's ongoing service efforts and their leadership model, Leader in Me®. Students engaged with leadership and empowerment principles by connecting what they learned in class to a real-world application though service activities. This real-world application gave teachers an opportunity to engage students in creating solutions and working together to accomplish something that was beyond their local community. A community partner stated:
Real-world projects are important because students need to have that connection. Service-learning teaches students that they can give back to the community and I think that is important to instill in students as it helps to shape them as better leaders.
Findings from this study suggest that mutual benefit for partners is a significant factor contributing to the sustainability of a CAP. At the end of the fourth year, the elementary school experienced both staff and leadership transitions. Specifically, the principal and several teachers were transferred to another school within the system. Although these transitions impacted the sustainability of the service-learning CAP, new opportunities emerged. A new partnership was established between the university and the middle school where the principal and several teachers now reside. This new partnership is focused on a community-based participatory research project examining school-based interventions to address the mental health needs of adolescents. Although not service-learning, this community-engaged approach continues the spirit of mutual benefit that was established in the first partnership. More importantly, many of the second graders involved in the service-learning project will potentially benefit from the community-based participatory research project currently underway.
School of nursing partnerships with elementary schools are often focused on providing a health intervention for school-aged children (Adams, Drake, Dang, & Le-Hinds, 2014; Bassi, 2011; Commendador & Flood, 2016; Tucker & Lanningham-Foster, 2015). We suggest broadening this focus to include partnerships that explore what different populations of students can accomplish together through service. Service-learning is a valuable educational strategy offering students an opportunity to apply classroom content to real-life situations. These real-life applications build competencies that are necessary for nursing practice (Murray, 2013). Although service-learning has been understudied in elementary school students, recent inquiry has demonstrated a positive effect on community engagement in areas such as connection to the community, civic awareness, and civic efficacy (Scott & Graham, 2015).
To increase capacity for sustainability of service-learning CAPs, the following strategies are recommended. The majority of partnerships (65%) are moderately structured and lack a formal contract and/or clear management structures (De Geest et al., 2013). The absence of a formal contract may jeopardize sustainability of partnerships—therefore, investing time into constructing a contract is recommended. Investigating benefits of service-learning partnerships is critical to sustainability as well. Thus, a guiding framework for both project development and research is recommended to support the value of these partnerships (Voss et al., 2015). Faculty also need administrative support to engage in K–12 service-learning partnerships (Hunter & Botchwey, 2017) because these partnerships facilitate important relationship building within the community and provide a rich platform from which to investigate educational pedagogy.
Voices from the 400 second grade project leaders and international partners were not captured in this study. Future research should consider how these student populations can add to the authenticity of the findings while protecting their vulnerability. One strategy is to design studies that measure outcomes of problem-based learning. Problem-based learning, which is similar to service-learning, has been successfully measured in primary education students and has shown positive effects on knowledge acquisition, attitudes, and academic achievement (Merritt, Lee, Rillero, & Kinach, 2017). It is important to note the 11-year relationship with the international partners in Guatemala. Although the purpose of this study was to examine the benefits of a partnership between the university and a local partner, it is recommended that future studies include the perspectives of international partners using a triadic design.
Service-learning CAPs are critical to support educational objectives and clinical practice for nursing programs. These partnerships have the potential to broaden the perspectives of nursing students regarding how they might engage communities through service to uphold their social responsibilities as professional nurses. This study supports the use of service-learning partnerships to achieve mutual benefits including student service leadership development, service-learning curricula enrichment, and enhanced partner service initiatives. More importantly, this partnership planted a seed in the youth who were intimately involved with the project to consider service as an integral part of one's citizenship.
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