Service learning is increasingly being incorporated into institutional higher education settings with the benefits of meaningful community engagement, experiential and reciprocal learning, and application of theory with a focus on effective communication, cultural competence, and empathy (Voss, 2015; Brown & Schmidt, 2016). The definition commonly used for service learning in the 1980’s and 90’s was “integration of community service with academic coursework”(Chapin, 1998). The aim was to enhance student learning objectives and curriculum. This innovative teaching modality was designed to focus on social action and considered separate from the more conservative reflective community service approach (Chapin, 1998). Currently service learning is defined by the following criteria: the activities must be experiential; activities are designed to address individual and community needs through a structured learning experience; reflection on the experience is incorporated; and students are guided to embody reciprocity between themselves in their service and those they are serving (Yancey, 2016.).
It may appear that current nursing curriculum embraces service learning through clinical experiences however when the four elements above are considered, clinical experiences alone fail to fulfill all the critical components of service learning (Yancey, 2016). There has been much discussion surrounding the benefits of including service learning in nursing curriculum however the debate continues regarding if this type of learning experience should be structured or unstructured in nature. Yancey (2016) concluded that although placing nursing students in unstructured experiences may put them at risk for cultural discomfort, the benefits of including activities without clearly defined objectives are particularly important when working with indigenous populations or those who do not subscribe to the core concepts of Western style education or healthcare (Yancey, 2016). Futhermore, curriculum that does not include service learning may act as a barrier to practical application of knowledge and skills, exposure to multicultural experiences, multidisciplinary collaboration, community engagement, and experiential learning. With this in mind, nursing program faculty and educators require support in defining service learning, understanding the objectives and benefits, understanding the implications for those providing and receiving services, and implementing a framework within their program to provide students with meaningful and comprehensive community based service learning opportunities. The purpose of this research project was to explore the impact of community based service learning on undergraduate nursing students’ achievement of university institutional mission-based learning outcomes and nursing student learning objectives.
Methodology
Photo elicitation interviewing, also known as Photovoice, is utilized to mitigate barriers between participants and researchers (Polit, 2012). This methodology is also considered a valuable tool for reflection and self-evaluation by reinforcing learning through the process of choosing a photo and expressing how it demonstrates a concept (Amerson, 2014). Photovoice methodogy was utilized by the ten junior and senior baccalaureate nursing students from a small, four year public learning institution in southern California who participated in this study. The participants were required to be a currently enrolled university student, aged 18 or over, having access to a digital camera, and able to consent to participate in the study via written form in English. They were also required to volunteer at the collaborating church based faculty-student run community clinic at least three times during the study period. These volunteer activities could either be structured or unstructured in nature.
Participants were asked to submit three to five photographs for each meeting representing the aims of the study. Instruction was given on basic photography and obtaining of informed consent when using photography. The participant group met five times over a seven-week period to discuss their photos. A total of 80 photographs were submitted and 47 were discussed. Discussions were recorded and transcribed by the researchers and common themes and barriers were identified.
Results
Community based service learning impacted the participants by:
- Enabling fulfillment of the university service learning mission statement and related nursing program student learning outcomes.
- Providing opportunities for reciprocal learning and collaboration between students, community members, organizations, and peers.
- Developing confidence in application of learned skills from nursing curriculum and nursing theory.
- Enhancing cultural competency and understanding of the community needs of vulnerable populations and those at risk for health inequities/disparities
Discussion
Service learning enhances cultural competency among students and can improve interactions with vulnerable or underserved populations. When participating in service learning, with a minority or immigrant group, students become engaged with new populations and improve their ability to communicate and work among diverse groups of people (Amerson, 2014). Nursing students are taught how to work with vulnerable populations and diverse aggregate groups. Development and practice of these skills are essential to their attainment of related learning outcomes. Students also identified that their experiences within the community were unique from previously assigned coursework and other class requirements. For nursing students specifically, clinical curriculum is typically focused on the delivery of individual patient care, however service learning provides an opportunity for nursing students to participate in inter-professional interaction and meaningful community engagement (Buff et al., 2014). Student participants not only felt that service learning offered a unique learning opportunity but they also felt that they would not have been able to fully meet general nursing program and course objectives without their participation in voluntary service learning experiences.
Limitations of this study include a lack of diversity in study participants and consistency of participant attendance in discussion group meetings. Although interdisciplinary student majors volunteer at the study site regularly, nursing students make up the majority of students who staff the clinic site thus the lack of participation of students from other disciplines was a further limitation.
This study explored nursing student perceptions of community based service learning and the impact it has on their fulfillment of the university mission statement and mission-based learning outcomes, individual course content, and nursing student learning outcomes. The findings depict service learning as an essential component to higher education and the fulfilment of related learning objectives not only for nursing student coursework but also for the university as a whole. Participants expressed their service learning experiences as having a positive impact on student learning, personal and professional development, and on educational outcomes. Student participant responses were consistently positive in nature, thus supporting the literature by emphasizing the benefits of this innovative teaching modality. Consideration should be given to incorporate this strategy across the nursing curriculum to further enhance community based learning.