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How can the pedagogy of engagement in the human condition ignite the soul of a nursing student and foster exploration of issues such as culture, gender, sociopolitical and economic status that underlie quality of life and health disparities? According to Fong (2014) soul-making is the interaction of the intelligence, the human heart and the world. Service –learning activities have the capacity to create soul-making experiences that can foster a global identify for students and create opportunities where the merging of intelligence and distressing human conditions can enable the maturation of the heart and create a transformative impact.
The nursing literature and nursing’s professional organizations abundantly support the inclusion of curricular goals that seek to foster the development of social responsibility within the nursing student. The American Nurses Association Code of Ethics and the International Council of Nurses emphasize that nursing education must inform and engage students in an understanding of the barriers to health and the complex social problems of our time such as poverty, unsafe and inadequate living conditions as part of the ethical and social responsibilities of the nurse (Kelly, Connor, Kun, and Salmon, (2008) & Tyer-Viola, Barry, Hoyt, Fitzpatrick, and Davis, (2011). Belknap (2010) and Mill, Astle, Ogilvie, and Gastaldo (2010) urge nursing educators to develop strategies and experiences that foster an understanding of social justice issues and the development of local and global citizenship. Student experiences with social justice assist them in transferring a sense of social responsibility into their professional careers (Redman & Clark, 2002). Nussbaum (1997) (as cited in Fong, 2014) proposed that higher education should strive to cultivate the humanity of the student through asking them to “critically examine themselves and the society that has formed them”. Also, higher education should support “exposing students to the unfamiliar and variety in the world. “ Furthermore, the development of empathy can be engendered through experiences that “rouse a sense of human connections” (Fong, 2014, p. 31-32.)
Methods:
Immersion with an underserved population, providing basic health care to residents in the Dominican Republic provided opportunities for soul-making and transformation for nursing students as well as the fostering of a global identify and subsequent “call to action” for social responsibility. Nursing students were invited to participate in a qualitative research student grounded in the phenomenological approach of Paul Colaizzi (1978). The purpose of this “lived- experience” qualitative study was to capture the meaning and significance of this experience for these 24 junior and senior nursing students.
In partnership with Good Samaritan Hospital and Maranatha in the Dominican Republic, Gwynedd Mercy University nursing faculty planned and participated in an immersion experience with nursing students and the residents of the sugar-cane communities (bateyes).The week long trip of 2013 was the sixth trip to this region. Several weeks preparation involved educating students on the history and culture of island of Hispaniola (Haiti and the Dominican Republic). These weekly meetings involved discussion on the challenging life circumstances of the residents and how these living conditions differed from their lives. In preparation for this service -learning experience, students were requested to familiarize themselves with global critical concerns such as the earth, nonviolence, women and children, racism, and immigration.
The students were invited to anonymously record their perceptions based on their interactions with the residents through describing their observations and reflective comments in a double-entry journal. The logistics of using a double-entry journal were explained in a meeting before departure on the trip. Each student was given a copy of the booklet, Nurturing the Global Citizen Withinand asked to read and reflect on the messages in the booklet. The objectives of the journaling were shared: 1) to reflect on the lifestyle of a person in the Dominican Republic compared to your own. 2) To engage with the global critical issues and apply these concerns to observations in the Dominican Republic. 3) To reflect on the Dominican Republic experience and its’ impact on your life as a person, professional nurse and citizen of the world.
In addition, specific question prompts guided students in their reflections. Selected examples of question prompts included the following: What emotions did you experience as you reflect on the day’s observations or encounters? What does the phrase “the luck of birth” mean to you as you reflect upon the day? How can reflection on critical global concerns in the Dominican Republic impact your own life? How does this reflection assist you in expanding your world view? How can you continue to nurture the global citizen within you? How did your service to the residents of the Dominican Republic in the bateyes enhance your commitment to social responsibility related to one or more of the critical concerns?The researchers were cognizant that student reflection has the potential to generate an upsetting emotional response. In this event, a psychiatric nurse was available for counseling.
Results: Data analysis involved extracting significant statements from the anonymous student journal entries and identifying the major themes from the study. Examples of themes that emerged were gratitude, appreciation, advocacy, transformation described as increased cultural sensitivity, personal growth and understanding of global issues as well as a commitment to social justice. Sample significant statements from the student journal entries were the following:
Why am I so privileged and lucky to have been born into a huge loving family and to receive so many privileges throughout my life. But maybe these people are the lucky ones…maybe we are too lucky for our own good…they live such simple lives…even though these people had little to nothing, they all seemed content…..I am angered by the way our American society constantly has an insatiable need for consumption….
I wish more people were able to experience a mission or service trip where they could become more grounded and humbled…I feel grounded in who I am, what I have become and who and what I want to be in life…this service enhanced my commitment to social change
It is important to be reassured of your reason for entering a profession…with regards to social justice, nursing should be advocating for the justice of people such as these…this experience not only humbled me, but it allowed my heart to feel things that it never felt before….I need to educate myself economically, politically, socially, culturally, technologically, environmentally to research the social injustices around the world….. I am trying to be an informed global citizen…I must live in such a way to make the world a more sustainable place…I internalized the value of being a global citizen and it has changed both my aspirations and desires in life….
I need to educate myself economically, politically, socially, culturally, technologically, environmentally to research the social injustices around the world….. I am trying to be an informed global citizen…I must live in such a way to make the world a more sustainable place…I internalized the value of being a global citizen and it has changed both my aspirations and desires in life…..Awareness is a start but I must lead by example… I gained a greater understanding of reducing racism, promoting peace….. I now feel an investment and pride in the global society…. I find myself being more compassionate to others even just in small things…it is our duty to reach out and help those in need… I am determined and willing to do what is needed……this experience has developed as a nurse and a human being….made me more culturally sensitive and caring…I found an enhanced respect and value of all the concerns: nonviolence, racism, earth, women and immigrants. Commitment to have a positive impact and influence positive change to end suffering and help less fortunate.
The limitations of this study involve the small sample size as well as the self-reporting limitations of the participants. In addition, although data analysis clearly revealed the transformative shift in perspective for these students, the researchers question if these changes will endure for these students. Currently, follow up dialogue with students is being explored to assess the long term impact of this service-learning experience.
Conclusion:
The research findings suggest that this service-learning experience has contributed to the soul-making and has had a transformative impact for these students as well as fostering the global identity for these students through increasing awareness of the complexity of global challenges. Reflective comments articulate the cognitive dissonance of the students having encountered human beings that struggle for basic survival. Despite the unsettled thought processes that were stimulated, students conveyed that the experience has inspired them to increase their knowledge as a local and global citizen and strive to become more socially responsible.
Moreover, the findings substantiate the rationale for continuing and increasing opportunities for future students to participate in immersion service learning experiences and other soul-making activities.