Community engagement is an emerging form of pedagogy in nursing education. This pedagogy requires that students and faculty go beyond the traditional classroom setting to generate meaningful experiences through projects linking nursing programs with the needs of communities. Professional nursing organizations provide faculty with recommendations for community engagement education. For example, a National League for Nursing hallmark of excellence for nursing education states that partnerships for engagement should both benefit the community and expand student service-learning opportunities. The national nursing honor society Sigma Theta Tau International advises nursing volunteers to include collaboration, sustainability, and equitable partnerships in their service projects (Dalmida et al., 2016).
Strategies faculty use for reaching out to communities include service-learning and volunteering. Service-learning combines curricular course learning goals with community service to enhance both student growth and the public good. The faculty role in service-learning has been described as including four functions that extend beyond the classroom: initiator, collaborator, facilitator, and advocate (Kohlbry & Daughtery, 2013). Through these functions, the educator organizes the service-learning experience, facilitates works with a community group to offer the service-learning, coordinates the logistics of the project, and promotes future student service-learning opportunities.
Volunteer service also serves the public good but is not necessarily embedded in a course. Academic support for community-engaged volunteering helps students in co-producing their own learning (Bell, Tanner, Rutty, Astley-Pepper, & Hall, 2015). It has been suggested that support from their faculty motivates nursing student volunteers (Dyson, Liu, van den Akker, & O'Driscoll, 2017). Currently, specific guidelines for the faculty role in facilitating student volunteering is missing from the nursing literature.
Purdue University Northwest, located in northwestern Indiana, values faculty involvement in community engagement. The College of Nursing supports curricula that foster a commitment to critical inquiry through experiential learning, civic engagement, and community partnerships ( http://www.pnw.edu). Two of the authors (J.H.D., C.R.) teach in the baccalaureate program's senior-level community health nursing course. During the students' community health nursing clinical at a local correctional facility, the third author (D.M.), who is the facility's RN, shared his Remote Area Medical (RAM) weekend volunteer service trip experiences. The students were inspired to volunteer with RAM and asked the faculty for help in making student weekend service trips a reality.
The RAM mission is to prevent pain and alleviate suffering by providing free quality health care to those in need. Its vision is “to be the best at operating clinics which enhance quality of life through the delivery of competent and compassionate health care to those who are impoverished, isolated, and under-served.” Since its founding in 1985, the nonprofit organization has provided free care worth more than $135 million in more than 1,035 clinics, serving more than 785,000 individuals and 68,000 pets. Funding for the organization is completely through private donations and foundation grants; no government funds are used ( http://www.ramusa.org).
RAM uses an established organized system to respond to community health care needs nationally. After being invited by a community sponsor committee that secures the venue, the RAM staff schedules the weekend clinic. Health care services provided at the clinics include chiropractic alignment, dental care, general medicine, immunizations, massage therapy, podiatry, vision screening with provided eyeglasses, women's health, and veterinary referrals for pet neutering. All of the equipment and supplies needed to provide the services are provided through RAM. The organization welcomes involvement from both lay and health care professional volunteers. RAM student volunteers have included dental, medical, pharmacy, and nursing students (Nierenberg et al., 2018).
This case study describes collaboration between two faculty members and a RAM volunteer RN to develop community engagement service weekend trips for undergraduate nursing students. A unique aspect of the collaboration is that responsibilities were shared between the faculty and the RAM RN in a trip co-facilitator role. This collaboration reflects the pedagogy of engagement in three ways. First, the student volunteer service was clearly for the public good as determined by open and thoughtful discussions between the faculty members and the RAM RN. Second, knowledge was co-created through the student volunteering in a unique nontraditional setting. Third, mutual respect guided the co-facilitators in applying their past experiences and combining their skills throughout the project (Núñez, 2014). The RN had volunteered with RAM since 2016, participating in more than 45 clinics, in a variety of service and leadership roles within the organization. One faculty member had directed study abroad programming, and the other faculty member supervises student community health clinical sessions. These combined experiences and skill sets were helpful in organizing travel with students and in anticipating possible hurdles.
A common concern about community engagement projects is the faculty time commitment involved (Cardinal, 2013). It did take a significant amount of personal time to develop the volunteer trips. In addition, each trip meant that the faculty members were away from home for 4 days. Faculty paid for their travel expenses through their university professional development fund account. They were not compensated for their volunteered time as trip co-facilitators. A strong, shared commitment to social justice drove the co-facilitators' determination to realize the project's objective (American Nurses Association, 2015).
The objective was to organize a weekend of volunteer service applying the students' nursing knowledge to an underserved community's needs. The trip co-facilitators had a number of informal discussions about the trip via telephone, e-mails, and texts. The first step in planning was pre-trip consultation with RAM staff about choosing the service weekend locations and dates. Locations within a day's drive were targeted as a reasonable commitment. Students would travel on Thursday after-noon, volunteer for Friday and Saturday clinics, and then return home on Sunday. The faculty members were responsible for completing all pre-trip required university paperwork including group travel insurance. They applied for multistate RN licensure for practice credentialing.
To formalize group communication, the co-facilitators developed a handbook posted on the College of Nursing website. The handbook included university policy on student code of conduct, requests for Americans With Disabilities Act (ADA) accommodations, and class absences. In a predeparture meeting, the co-facilitators jointly advised the students about registering as a volunteer with RAM, travel details, and what to expect each day of the clinic. Students needed to be in compliance with the College of Nursing current immunization, tuberculosis screening, and bloodborne pathogens training policies. They provided a copy of current health insurance coverage and an emergency contact. Students self-funded their travel, lodging, and meal expenses. They wore their College of Nursing scrubs at the clinics and used their own stethoscopes.
There is a cap on how many residents can be seen each day at a RAM clinic based on the number of volunteer providers at the site. Patients come from miles around the clinic sites, including from surrounding states, and many sleep in their cars overnight to ensure that they will be in line for care. On each full day (6 AM to 6 PM) of the clinics, students were greeted by the volunteer RAM RN co-facilitator. He provided a site orientation and introduced the students to RAM staff members and other volunteers. The students then reviewed the RAM “Nursing Triage Orientation Binder” guidelines and practiced completing clinic documentation.
The students were seated at folding tables that functioned as assessment stations. To support student confidence in this new setting, the faculty co-facilitators demonstrated greeting each patient with a warm welcome such as, “Thank you so much for coming to see us today. This nursing student will get you started for your services.” The students initiated patient intake by obtaining a history of health conditions that especially impact dental procedures such as infectious diseases, cardiac conditions, and surgical procedures including organ transplants. Students recorded a medication history and took vital signs for each patient.
At times, the students were unsure of their assessment findings, and the faculty constantly circled back to the assessment stations to help validate their findings or to suggest alternatives for obtaining vital signs, such as using a different size blood pressure cuff. Patients with blood pressures outside the accepted range or other concerning assessment findings were re-screened. Patients then were escorted to their requested service, such as dental or vision care. Throughout the day, providing needed services such as re-screenings, offering flu immunizations, autoclaving dental instruments, giving postprocedure dental extraction care, and assisting with vision screenings generated co-learning among the student volunteers.
During the 2018–2019 academic year, 21 undergraduate nursing students participated in the service weekends. The fall semester 2018 trip was to Johnson City in the Appalachian region of Tennessee. This weekend clinic was held at the local fairgrounds. The Johnson City RAM clinic served a total of 808 patients, providing $556,768 in services. The spring semester 2019 trip was to Ashtabula, Ohio, a Rust Belt community where the clinic was held in a closed chain department store building. The Ashtabula clinic served 1,650 patients, providing $917,949 in services to patients. These tangible outcomes of the trips provided strong rationale for continuing student opportunities to volunteer with RAM. In addition, students could apply their volunteered time to some university course requirements for community service, which also helps sustain future student interest.
Personal characteristics of the co-facilitators that fit with the community engagement settings included flexibility and an ability to calmly manage multiple expectations throughout the day. A positive, good humored demeanor also helped the entire group cope with last-minute changes to plans that developed over the weekends, such as a new 4:00 AM start time. Demonstrating mutual respect to all without judgment when confronting underserved community issues during the trips was essential. It was important for the co-facilitators to be receptive to serious conversations with students about their personal and career goals for community-engaged service after graduation. “I want to volunteer again,” and “How can we bring RAM to our community?” were typical student comments about the experience.
The nontraditional RAM volunteer service environment fostered direct engagement with underserved populations nationally. The community-engaged pedagogy provided a framework for building capacity between an academic and a community organization for student volunteer service. The trip facilitators' collaboration resulted in a positive and productive community volunteer service experience for undergraduate nursing students. The students gained first-hand experience in seeing their faculty collaborate as a team with the volunteer RN to support the pedagogy of community engagement. The co-facilitators jointly modeled how to respectfully serve community members, demonstrated how to overcome logistical hurdles, and supported the students' emotional connections with the RAM service mission.
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