Outcomes of a Bystander Intervention Service Learning Project in a Pre-Licensure Nursing Program

Purpose: The purpose of this project was to explore outcomes from the integration of a bystander intervention, service learning project into a pre-licensure nursing program. The bystander effect is a well- known social phenomena where  ambiguity and diffusion of responsibility result in the failure of individualsto assist others in need (Bennett, Banyard, & Garnhart, 2014; Darley & Latane, 1968). Alarming trends in preventable injuries and assaults among college students have led some campuses to explore ways to teach bystander intervention as a means to improve safety and well-being (Coker et al., 2011; Gidycz, Orchowski, & Berkowitz, 2011; Reid, Irwin, & Dye, 2013). Specifically, one large public university in the Midwestern United States created a campus-wide, bystander intervention initiative to promote awareness, compassion, and courage among students called “Culture of Care.” The initiative focuses on improving sexual well-being, mental health, alcohol and drug awareness, and respect among students.  Consistent with the American Nurses Association’s (ANA, 2014) position that nurses have an ethical responsibility to collaborate with the public to improve the health and safety of communities, we created a service learning project at the same university in a beginning level nursing course to support the Culture of Care initiative. The research questions that guided this study were “How did the nursing students improve the campus’s well-being?” and “How did participation in the bystander intervention service learning project help promote students’ professional development?” 

Methods: We obtained IRB approval to conduct this mixed-method study. Over the course of two years, all BSN students enrolled in a required entry level, Healthy Populations clinical course (N=120) participated in a 4-hour training on bystander intervention. Students then received instructions to spend a minimum of 6 hours engaging in activities of their choice that promoted a least one of the four Culture of Care focus areas over the course of the semester. Students recorded their hours in their clinical logs and reflected on their experience through group discussion and in a written journal.  We used a case study design to gain a holistic understanding of the intended and unexpected project outcomes. Quantitative data from student’s time logs was mapped to qualitative data from the students’ reflective journals using Dedoose Version 5.0.11software.

Results: Data showed that the majority of students (77%) devoted at least part of their hours to the drug and alcohol awareness focus area. Students served the university by spending their time acting as sober monitors or designated drivers (324 hours), creating alternative to drinking activities (269 hours), joining groups or attending meetings related to the Culture of Care focus areas (177 hours), participating in community awareness events (77 hours), taking friends to Culture of Care related lectures (75 hours), and working with small groups or individuals (62 hours).  Approximately one third of the students (35%) described a specific incidence where they used their training in bystander intervention to assist an individual in need beyond acting as their designated driver.  Analysis of student journals revealed that students engaged in caring occasions while gaining skills as leaders, activists, and educators, and participation in this project helped the majority of students appreciate their personal responsibility in community safety.

Conclusion: While this pilot project involved 120 students dedicating a total of over 980 hours to campus well-being, the student logs suggested the impact was much further reaching. Nurses are leaders and advocates who have a moral responsibility to promote the health and safety of all people (ANA, 2014), but traditional methods used in pre- licensure education have not always led to the development of strong leaders (Hensel & Laux, 2014; Hensel, Middleton, & Engs, 2014). Very early in the curriculum, this service learning project gave novice nurses an opportunity to cultivate professional skills and values, including those related to safety and leadership, while functioning in a fairly independent manner. Future research is needed to determine if learning to act when things are not right in a community setting will transfer to the acute care setting where all team members are expected to intervene about safety concerns.