The purpose of this study was to evaluate an interprofessional service learning, undergraduate nursing course that combines a didactic diabetes focus with a diabetes camp to promote learning beyond the classroom.
Background/Literature Review:
Service learning is an established andragogy that aims to translate information presented in didactic courses to real-world situations. This unique teaching approach synergizes the classroom objectives and the application of abstract thinking, which is required in “real-life” situations. The aspect of abstract thinking involved in service learning includes social, ethical, and cultural aspects, which develops and fosters cultural diversity (Adegbola, 2013). Progression from instructive to experiential learning, reflection, and ultimately reciprocal learning, service learning bridges a gap between the classroom and practical application (Schmidt & Brown, 2016). When integrated into the nursing curriculum, service learning not only reinforces academic coursework, but also strengthens critical thinking, responsibility, accountability, and promotes students as change agents in their communities. An undergraduate nursing elective and service learning course (NURS411: “Topics in Healthcare Delivery: Teaching Wellness to Children) combines a didactic and clinical component in the form a diabetes camp.
Diabetes and You: Kamp for Kids (K4K) provides education, camaraderie, and support to children with T1D between 4-17 years old. There are typically 65-85 campers that attend each year, 50-60% of whom have T1D. The scheduled activities and games are based on one of the five topics: diabetes overview, physical activity, nutrition, stress, and “tying it all together”. Each topic is assigned to a different day of camp with different education modalities and learning to cultivate an understanding and knowledge about diabetes and healthy living of all campers.
Course Didactic Component: During the didactic portion of the course, students attend five instructional classes centered on the care and management of children with T1D and also develop the week-long day camp for children with T1D and their siblings and friends. One of the class days is an interprofessional education day sponsored by a local pediatric hospital focused on comprehensive approach to diabetes management. The students interact and learn from a pediatric nurse practitioner, registered dietician, and a psychologist who all specialize in endocrinology.
Traditionally, nursing students are taught using nursing textbooks and journals. However, this course textbook is the same book that parents receive in the hospital when their child is first diagnosed with T1D and is titled, Understanding diabetes: A handbook for people who are living with diabetes(Chase & Maahs, 2016). The students not only learn concepts to assist with camp management, but also the translation of these concepts into clinical practice including glucose management, leadership skills, team building, and conflict resolution. Each class begins with a quiz, followed by small group discussions and interactive activities about teamwork, leadership, conflict resolution. The evaluation methods used in the classroom includes quizzes, direct observation, group discussions, and reflective journals.
Course Clinical Component: The last week of the course incorporates the didactic components into the diabetes camp focused on health and wellness of children with diabetes and their friends/siblings. Each group comprised of four to five randomly assigned students is charged with organizing and managing the diabetes camp for one day. Each morning a pre-conference briefing is held before the campers’ arrival. Safety is reiterated and the logistics of the day are reviewed. Throughout the day, students learn through experiencing family interactions between and among siblings and parents at drop off. Students interact directly with the nursing and psychology staff regarding diabetes management and psychological aspects associated with children. Besides hands-on diabetes management, this course provides essential “life skills” including teamwork, conflict resolution, management, and interpersonal communication across the lifespan. The camp day concludes each day with a post-conference briefing to celebrate successes of the nursing students and campers. Students identify issues or concerns that occurred that day, which are then presented to the full class for resolution.
Methods:
With University Institutional Review Board approval, a mixed method design was used to evaluate the 400 level nursing elective, “Topics in Healthcare Delivery: Teaching Wellness to Children.” As part of the students’ NURS411 course assignments, the students (n = 23) completed a Perceived Confidence Survey in diabetes management during class. The survey was completed 2 days before the week of diabetes camp and again the last day of camp. This adapted survey used a four-point Likert scale for the eight questions, which included the following areas: communication with campers and families, hypo- and hyperglycemic assessment and treatment, insulin pump therapy, and empathy.((Johnson, 2007)) To avoid bias, faculty did not review the pre- or post-confidence surveys until after student grades were posted. Using the service learning approach, students completed a reflection analysis paper 48-72 hours after camp. As per faculty guidelines, the four to six paper consisted of six open-ended, adapted questions to focus on the course objectives.((Johnson, 2007)) With permission, students were allotted more pages if necessary. The pre- and post-perceived confidence surveys were analyzed using SPSS (version 23). Paired T-test analyzed each question of the pre- and post-perceived confidence survey using an alpha level of < 0.05. Content analysis of the final reflection paper was conducted by the professor and another author who are experienced in qualitative researchers.
Results:
The overall mean and standards deviation for the pre and post confidence survey results were 3.2 (.47) and 3.80 (.19), respectively. The largest difference between the mean among the eight questions was related to the students’ confidence in insulin pump therapy with a pre-camp mean of 2.35 (.71) compared to a post-camp mean of 3.48 (.59). Content analysis revealed four major themes with some having subthemes: pre-camp assumptions and fears, growth in confidence, understanding diabetes management in the community, and appreciation for learning beyond the classroom and hospital setting.
Pre-camp assumptions and fears: The students assumed that they would recognize a campers’ high or low blood sugar and that they campers would have a lack of knowledge related to diabetes management because they are nursing students and have more education about diabetes than children. One student said, “ …these kids know their bodies (which completely blew me away) and they knew when they were feeling low or high and they let their counselors know.” Another assumption was the expectation of chaos and the students’ planned daily schedules included times of all activities would not occur. One student said, “Although there was chaos in some rooms, it was filled with laughter, smiles, and balloons flying through the air.
Growth in Confidence: This course has a positive environment and students’ clinical confidence grows exponentially related to diabetes management, which is natural since the students repeated these skills many times throughout the week. However, managing multiple patients in the inpatient hospital setting and understanding that a nurse’s day is constantly changing requires excellent communication skills, delegation, and teamwork. One student said, “The preparation leading up to and the week of Kamp truly put us [students] in circumstances were leadership and delegation are necessary. Both of which are key components of nursing”. Students’ confidence in in themselves evolved throughout the course in many different areas. Another said, “I feel that I personally grew from a nervous and unsure nursing student, to a confident and self-sufficient counselor who is able to help challenge and inspire campers.”
Understanding Diabetes Management in the Community: Using camp to immerse the students into community, fostered the students understanding of how children with and without diabetes interact and manage diabetes on a daily basis. This experience is quite different than a hospital setting. One student said, “Caring for this population wasn’t just about giving shots, and checking glucose levels – it also meant negotiating their social circles, navigating their logical and mental routes and relating to them person-to-person, not just nurse-to-patient.”
Appreciation for Learning beyond the Hospital Setting: Students were able to gain new perspectives on caring for children with T1D. The hospital setting provides nursing experiences in an acute phase. However, there is much more to chronic conditions such as T1D that may only be understood when immersed in a community like setting such as a diabetes camp. One student said, “I never knew how much time and effort they [children with T1D] spent on diet and understanding diabetes …. [I have] respect for patients, families, and children, who have diabetes.” Learning occurs from a different perspective. One student said, “Kamp helped me learn and understand diabetes from the children and family perspective”
Conclusion:
Using a service learning approach, the faculty and nursing staff at Diabetes and You: Kamp for Kids are able to foster critical thinking and personal reflection through hands on experience of overseeing a diabetes camp and a reflection assignment. This course also provides a heightened sense of community engagement and responsibility not only to the campers and their families, but also to the camp staff and the students enrolled in the course.
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