A collaborative community partnership with the American Red Cross.

Abstract

Nursing educators have a responsibility to prepare nursing students to meet the challenges of a dynamic health care delivery system. It is a professional imperative that nursing students are taught to develop, optimize, and maintain interdisciplinary partnerships within the health care system as well as within the communities that are served. It is equally important that they are taught to respond to health issues and deficits that are identified by their communities, rather than rely solely on objective assessments. This is a service learning project that introduced pediatric nursing students to the theory and practice of addressing community-identified needs of youth in selected elementary and middle schools in a circumscribed mid-western metropolitan area. Nursing college faculty members established a working partnership with the local chapter of the American Red Cross (ARC).

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An Experiential Learning Tool

Service learning is a pedagogy that provides for structured learning experiences in the academic arena, combining community service with experiential learning objects (Seifer, 1998). Its implementation has been exercised in a growing number of educational programs across the nation, most recently in the annals of nursing academia (O'Neil & Coffman, 1998). Nursing professionals have expressed an interest and an excitement in the potential that service learning has for broadening the knowledge and practice bases of professional nursing education. Well planned service learning activities have been shown to enhance the relevance of the services that are provided by health care professionals and increase the students' awareness of civic responsibility (Norbeck, Connolly, & Koerner, 1998).

A form of experiential education, service learning encourages nursing students to engage in activities that stimulate critical thinking while attending to health issues identified by a specific community. The nursing students are guided in interactions that emphasize the reciprocity of interdependent alliances. Written reflections and small group dialogue augment their experience. Integral to the basic concept is the initiation of meaningful community partnerships (Jacoby & Associates, 1996). Such alliances pave the way for the development of respect and understanding between agency and academia, between professional health care providers and the communities that they serve.

Service learning is an innovative approach to teaching that is currently capturing the attention of nurse educators. Its greatest potential lies in the development of unique student clinical experiences that complement and strengthen basic professional skill sets. Community involvement is strengthened by affording its members an enriched capacity to improve its management of health-related issues. The utilization of this experiential teaching tool and its integration into traditional nursing curricula expands upon three significant curriculum components. First, the service provided directly responds to a need identified by the community. Second, the experience builds upon the nursing students' basic nursing skill sets. Third, interdisciplinary interaction fosters the stimulation of critical thinking.

Developing a Partnership

This specific project illustrates the practical application of the philosophy and implementation of service learning in a baccalaureate nursing curriculum. Pediatric nursing faculty members met to design a clinical experience that incorporated a service learning opportunity with pediatric nursing course outcomes. The didactic component of the pediatric nursing course focused on the promotion of health and wellness for children within the context of the family and the community. Clinical experiences traditionally support the development of skills that assist the nursing students in the successful accomplishment of the outcomes. This novel clinical project was not intended to supplant established clinical experiences. Rather, the project was initiated to provide an unique beneficial teaching/learning experience that complemented the integration of theoretical concepts with practical exercises in providing nursing care. The service learning project was a required clinical component for all nursing students enrolled in the pediatrics course.

The national American Red Cross (ARC) designs and distributes a significant amount of materials and supports an ever-growing number of programs for children and for adults. These programs are available to each community through local ARC chapters. Mr. Ray Baquero-Cruz, Safety Specialist/Grant Coordinator at the Heartland Chapter of the ARC in Omaha, Nebraska, was asked to participate in a service learning project in a partnership with pediatric clinical nursing faculty members at Nebraska Methodist College (NMC). He played an integral part in the initial stages of the project. His supervisor, the director of Health and Safety Services at the Heartland Chapter, Mr. Ector Thyfault, was very supportive, anxious to facilitate community education with the assistance of student nurses.

The initial collaborative community partnership was formed between Nebraska Methodist College (NMC) nursing faculty members and the Heartland Chapter American Red Cross (ARC) Safety Specialist, Mr. Baquero-Cruz. Two college nursing faculty members met with the program director and outlined the theoretical basis of service learning. A collaborative project was designed. The director was invited to envision and support the involvement of pediatric nursing students in the presentation of health and safety information to youth in the metropolitan area. The director's experience prompted him to the identify a community need that overwhelmed the resources of his department. He stated that several elementary school teachers contacted him with requests for age-appropriate presentations on a regular basis. The presentations most frequently requested targeted health and safety concerns such as water safety, first aid, how to recognize an emergency, how to act in an emergency, and safety at home and at play. This community-identified need and the resources available from the ARC to help meet the need were discussed at length. The development of a project that would encourage student nurses to present information on some of these topics to elementary pupils using some of the ARC materials on health and safety was initiated.

The partnership was then extended to include elementary and middle school teachers in selected public schools in the surrounding metropolitan area. The middle school was included after their school nurse called the college requesting student nurses to teach basic health and safety classes. An alliance between this particular middle school and the college had already been in existence for some time. The middle school had already been established as a "sister school" of NMC. This arrangement between the two academic entities was known as a "payback' partnership. In the Omaha metropolitan school system, each school developed an agreement with a business or another organization to foster support for its programs and community efforts. The extant relationship facilitated the initial efforts of the project. Permission was obtained from the principals of two elementary schools and the middle school to develop this project. Several of the teachers who had already contacted the ARC for safety presentations for their respective classroom students were the first teachers to be approached. In the elementary schools, teachers of the third and fourth grades participated; one third grade teacher was familiar with ARC materials and had used them in her class on a number of occasions.

The middle school nurse was the point of contact for his school. He was enthusiastic about the prospect of nursing students interacting with his pupils. He contacted three teachers: one physical education teacher, one Growth & Development teacher, and an eighth grade teacher. As the program progressed, the teacher of emotionally mentally handicapped class also welcomed the nursing students to present health and safety information to the class. Through the school nurse, each teacher became involved with the college nursing faculty by offering their participation. Health and safety topics for presentation were confirmed in discussions between the school teachers and the college faculty. Third and fourth grade pupils ranged in age from eight to ten years. Middle school pupils ranged in age from twelve to fifteen. The choice of topics was based on the general ages and developmental stages of the pupils as well as the preferences of the teachers. Over the course of two years (five semesters), 154 nursing students in pediatric clinicals at NMC presented health and safety information to 1,683 elementary and middle school pupils.

Student Orientation

Pediatric nursing students were introduced to the philosophy of service learning during clinical orientation. A basic outline of the practical experience was reviewed with them. They were told that they would be divided into groups of two or three for this clinical project. Each group would be responsible for the planning, preparation, and presentation of a fifty-minute educational session to a specific group of elementary or middle school pupils.

The content of each presentation was tailored to the requests of the elementary or middle school teachers. The materials and teaching outlines were secured from the ARC. The students were encouraged to expand on the materials available from the ARC and access other resources. Examples of other resources included injury prevention information from the Nebraska Chapter of the Society of Pediatric Nurses (NSPN) and information found on the Internet. Time was provided during several clinical post conferences for the nursing students to work together in their groups planning their presentations. Nursing faculty assisted them in the development of teaching plans, providing direction and support. The nursing students were required to practice their presentations. Students presented their teaching content and strategies to their peers, soliciting constructive feedback in advance.

School Presentations

The nursing students executed their teaching plans in the classrooms of the grades to which they had been assigned. Their respective pediatric nursing clinical instructors and the grade-school teachers were in attendance and, in some cases, participated in directed activities along with the pupils. Each presentation lasted fifty to sixty minutes and consisted of interactive instruction in an age-appropriate area of health and/or safety that had been requested by the individual grade-school teachers. Some activities were video-based. Most presentations included games or group activities to encourage the pupils' participation. Table 1 illustrates an example of a teaching plan. See issue's website <http://rapidintellect.com/AEQweb/spr2003.htm>

Each presentation was evaluated by the teacher. Evaluation of the nursing students' preparation and content delivery was a primary focus. Included in the evaluation queries was one question devoted to the identification of topics for future presentation. This information was important to the pediatric nursing faculty in planning for future semesters. All of the evaluations indicated that the pediatric nursing students' presentations had a positive impact on pupils in the elementary and middle grades. The pupils, themselves, were not given formal evaluations to complete. Their comments, suggestions, and remarks were noted by their respective teachers and shared with the pediatric clinical instructors on site. A number of the classes designed group or individual thank you letters for the nursing students who presented to them.

Following the presentations, the nursing students were required to write a brief paper reflecting about their experiences. The assignments have varied but the fundamental intent did not change. Table 3 is one example of an assignment designed to augment the philosophical foundation of service learning. See issue's website <http://rapidintellect.com/AEQweb/spr2003.htm>

The Benefits

The benefits promulgated by this pedagogy can be analyzed from several perspectives. While there exist benefits to each partner involved in the service learning project, each is realized uniquely. The primary benefit to the community is that their identified need is addressed. Community agencies, such as the ARC, benefit from service learning because they expand their capacity to respond to the needs and concerns of the community. They develop an enhanced awareness of the positive potentials that can be realized through the development of community partnerships with academic resources. Participation also provides them with an accurate account of the effectiveness of their programs through direct feedback obtained from teachers in the community.

In the academic arena, nursing students are initially taught to assess individuals. As their knowledge and skill base expand, these students learn to assess the needs of circumscribed communities. Programs and nursing diagnoses are identified as a result of these outcome assessments, targeted to ameliorate aberrant health and wellness issues. Service learning provides an additional opportunity for nursing students to apply their accumulated technical skills with critical thinking and therapeutic communication skills in the analysis of needs specifically identified by the communities they serve. Nursing students participating in service learning experiences benefit from the opportunity to provide pertinent community service. The students see first-hand the development of reciprocal partnerships between community factions and the academic milieu. They are afforded an opportunity to explore the connection between theoretical information in their courses and the practical application of the concepts. Nursing students also benefit from the identification of their roles as professionals and as responsible citizens (Richards, 1996). Table 4 outlines the number of nursing students who have been involved in this pediatric service learning project and the number of metropolitan school children who have been impacted by their presentations. See issue's website <http://rapidintellect.com/AEQweb/spr2003.htm>

College nursing faculty benefit from service learning. As a group, they are eager to create partnerships outside of the technical realm of the traditional clinical experience. Service learning affords them an opportunity to expand clinical experiences through the development of interdisciplinary partnerships. Nursing faculty can better mentor nursing students to function as responsible, civic-minded professionals, preparing them to meet the realities of a dynamic community-based health care system. Faculty can foster holistic partnerships between academia, community agencies, and the communities that they serve.

Summary

The intent of this article is to inspire academia to develop creative interdisciplinary and reciprocal partnerships with the American Red Cross and other community organizations. The American Red Cross, for example, offers a wide variety of teaching materials and curricula that target community audiences across the lifespan. There are health and safety programs as well as disaster preparedness classes, pet safety, and team sports programs. The development of partnerships between health care professionals and community agencies creates a venue for the tremendous untapped potential of integrative services. The provision of service learning experiences in traditional undergraduate and graduate nursing curricula creates a wealth of new opportunities for the stimulation of civic awareness as well as for the validation of practice-based research in nursing.

Note

A Service Learning partnership between the American Red Cross and Nebraska Methodist College was initiated by Kathleen Pepin and Susan Ward when they were both on faculty at the college in 1998. The service-learning project was designed as a clinical experience in the community for pediatric nursing students.

References

Jacoby, B. & Associates. (1996). Service Learning in Higher Education: Concepts and Practices. San Francisco, CA: Jossey-Bass.

Norbeck, J.S., Connolly, C., & Koerner, J. (eds.). (1998). Caring and Community: Concepts and Models for Service-Learning. Washington, DC: American Association for Higher Education.

O'Neil, E. & Coffman, J. (eds.). (1998). Strategies for the Future of Nursing: Changing Roles, Responsibilities, and Employment Patterns of Registered Nurses. San Francisco, CA: Jossey-Bass.

Seifer, S.D. (1998). Service-Learning: Community-Campus partnerships for health professions education. Academic Medicine, 73 (3), 273-277.

Kathleen E. Pepin, Nebraska Methodist College, Omaha
Susan L. Ward, Nebraska Methodist College, Omaha

Mrs. Pepin, MSN, RN, works part-time teaching Health and Safety Services classes for the Heartland Chapter of the American Red Cross. Dr. Ward, PhD, RN, is an associate professor and teaches pediatric content and clinicals in the Bachelor of Science in Nursing (BSN) program.