This pilot project aimed to evaluate the integration of second-semester Accelerated Baccalaureate Students (ABS) into a service-learning community experience for low-income elders. A near-peer teaching approach was utilized to enhance student learning. The AACN Baccalaureate Essentials were used to guide the implementation and evaluation of the service-learning experience.
Methods: Eleven second-semester and twelve fourth-semester ABS students were paired in learning dyads in a low-income ethnically diverse urban housing development, along with an interprofessional team consisting of community health workers and social workers. Second-semester students were mentored by fourth-semester students, supported by a PharmD faculty member and Advanced Practice Nurse (APN) faculty members. Students visited residents in their apartments, accompanied by a social worker or community health worker. As 65% of the building residents were Spanish-speaking, the social workers and community health workers served as interpreters when necessary. Students performed health screenings, health promotion education, and medication reconciliation and medication counseling. Interprofessional case presentations, led by the second-semester student, promoted teamwork and communication. The fourth-semester student mentored the second-semester student during and after the resident visit, and in preparation for the case presentation.
At the completion of a two-day encounter, students completed a survey to evaluate how the experience affected knowledge, skills, and attitudes about social determinants of health, interprofessional teamwork and communication, advocacy, patient-centered care, and influence of cultural values on healthcare. A retrospective pretest/posttest format was used to evaluate change in knowledge, skills, and attitudes on a five (5) point Likert scale. Descriptive analysis of frequency, mean and standard deviation were analyzed. Paired t-test analyses were performed to evaluate significance. Responses from open-ended survey questions were also analyzed for common themes.
Analysis of Results: The highest rated variable related to the role of social determinants of health in the overall health of the residents (M=4.38). Paired t-test analyses indicated that there were significant positive increases in the level of knowledge reported (average of nearly a 1-point increase, 0.86) for all five content areas (culture and health care, social determinants of health, advocacy and collaboration, integrating patient values in health care decisions, importance of interprofessional team-based approach, p<.05). Open-ended comments centered around themes of advocacy in poverty, patient-centered care, and the value of meeting people where they live. Second-semester students appreciated the mentoring provided by the fourth semester students. Students recommended to expand the project time from two days to a full seven-week rotation. Students valued interactions with residents and expressed that a longer rotation would facilitate relationship building and increase the opportunities to impact the health of the community.
Summary/Recommendations/Conclusion: Students reflected an appreciation of the complexity of healthcare issues affecting vulnerable members of the community and identified the importance of providing comprehensive care across the continuum. Based on survey results, future semesters will expand the experience from two days to a full seven-week rotation. With the project expansion, specific population health screenings will be added to the services offered to the building residents. Consenting residents will be screened for dementia, depression, and fall risk to identify at-risk elders so that early intervention can be provided.