The real world: service, learning and missions.

Abstract

Locating optimal community sites to implement community service and learning projects often proves challenging. Because nurse managed health centers partner with communities in which they serve, they are an excellent venue to implement community service and learning activities. This paper explores how several collaborative disease prevention and health promotion projects, conducted by undergraduate nursing students in an academic urban managed health center, meet the missions of the school of nursing, the academic nurse-managed health center, and the university. Student reflections are also emphasized.

Introduction

"When I see what looks to be a homeless person on the street, I now realize that he has a story to tell about how his life got to be this way"

Community Service and Learning (CSL) is defined as a teaching and learning strategy that integrates meaningful community service, instruction, and reflection to enrich the learning experience, teach civic responsibility and strengthen communities (National Service Learning Clearinghouse, n.d.). The Corporation for National and Community Service cite Eyler and Giles (1999) who suggest several characteristics of CSL: supporting learning through active participation in service experiences; promotion of cooperation rather than competition and thus providing teamwork, providing an opportunity for students to use skills and knowledge in real-life situations; extending the learning beyond the classroom and into the community; and provision of structured time for students to reflect by thinking, discussing and validating their experiences. The "service" and the "learning" components are equal; no one part holds greater weight. Each component enhances the other (Sigmon 1994).

University Overview

La Salle University, located in Philadelphia Pennsylvania, has as its primary goal to graduate students who understand, value, and accept their responsibility to become active citizens in their communities and assume leadership roles. Evidence of this commitment can be seen in University's statement of Lasallian values: "La Salle prepares students for progressive leadership in their communities and strives to develop in them sensitivity for the dominant ethical issues that confront society. We want to develop in our students sensitivity to the needs of others, particularly the poor, through course work and service opportunities sponsored by and for students." (La Salle University 2005a).

La Salle University, the School of Nursing and its Neighborhood Nursing Center have mutual goals to meet the needs of its neighbors. These include:

* The University's statement of Lasallian values as stated above.

* The mission statements of the School of Nursing and the Neighborhood Nursing Center

* The core curriculum, including Understanding at Home and Abroad, requires that students have sustained involvement in community service.

* More than 50 professionals including Deans, faculty and administrators who are members of the Service-Learning Study Group.

* The number of service-learning courses currently offered is twenty-eight as of the Fall 2005 term.

The vision statement of the Division of Student Affairs: "Our work also will reflect our attention to the spiritual elements of Catholic university life and to potential impacts on our neighbors in the surrounding communities. We will actively collaborate with all other members of our University, local, and professional communities in the fulfillment of our responsibilities." (La Salle University 2005b).

La Salle Neighborhood Nursing Center

Currently, the largest school within La Salle University is the School of Nursing, offering full and part time undergraduate basic nursing programs, an RN-BSN program, an LPN to BSN program, and several graduate programs tracts including nurse practitioner, clinical specialist, nurse anesthesia and public health. The mission of the SON is "to provide excellent education programs to develop culturally and clinically competent, caring, nursing and health science professionals and to prepare each student for a life of continued learning. Undergraduate and graduate students engage in educational programs that develop appreciation of the autonomy, dignity, spirituality, complexity, and diversity of the people they serve. Students think critically, communicate effectively and possess a comprehensive body of knowledge about the health status of individuals, families, groups, communities, and populations in a changing world". (La Salle University 2005c).

La Salle School of Nursing (SON) is the La Salle Neighborhood Nursing Center (LSNNC), a nurse managed health center. A nurse-managed health center is a community health center that may or may not be affiliated with an academic institution. A nurse-managed health center employ nurses and other interdisciplinary members of the health care team to provide primary care and/or public health programs to the target population. What makes nurse managed health centers unique in the United States health care delivery system is that oversight to all center operations is conducted by a nurse who holds an advanced degree in nursing, not in administration, finance, or some other discipline. According to Kinsey and Buchanan (2004) nursing center models combine human caring, scientific knowledge about health and illness, and understanding of family and community characteristics, interests, assets, needs and goals for health promotion, disease prevention and disease management. Since nurse managed health centers have established relationships with the community in which they serve, a nursing center model is a perfect fit for CSL experiences. The mission of the LSNNC is "through the development and implementation of exemplary public health and educational programs, the La Salle Neighborhood Nursing Center supports and enhances the teaching, learning and service mission of the School of Nursing." (La Salle University 2205d).

Health Science Elective Courses 

Contemporary students must have the opportunity to look beyond the narrow boundaries of their own life experiences. Community service learning provides a venue to prepare students for progressive leadership in the community. This requires more than fleeting service experiences. It also requires partnerships that are borne of mutual interest and commitment to both students' growth as well as supporting the community to meet its own goals. The purpose of incorporating a CSL component into the nursing curriculum was to provide a legitimate experience whereby students could apply theoretical content to a community setting. Health sciences elective courses at this urban university require four hours of CSL during the semester. These courses were viewed by administration and faculty as being appropriate for CSL experiences due to the topics addressed within the courses. Topical areas include, but are not limited to, vulnerable population groups, health literacy, cultural diversity, urban environmental health risks, and insurance issues and trends. The CSL experience was designed to address course objectives in the following health science courses: Unhealthy environments, healthy solutions; Plagues and epidemics; Cultural diversity: The birth of a nation; Health communication: A multimedia approach; Special populations: The health of urban men; and Urban health: Families in jeopardy. Examples of course objectives include: define the collaborative relationships necessary to support health of urban populations, describe environmental indicators used to determine urban health risks, examine the disproportionate burden of ill health for the urban populations, analyze an important historical or political event from a cultural perspective and reflect upon challenges of health education for urban populations. These course objectives are compatible with the mission statements of the University, the School of Nursing, and the Neighborhood Nursing Center as described above.

Community Service and Learning Experiences

Some exemplars of CSL experiences that originate from LSNNC programs are:

* "Reach out and Read". In this program at a primary care clinic, students read age appropriate books to children in the waiting room of the primary care office while they or their parent/guardian are waiting to be seen for an office visit. A new book is given to each child who participated in the program at the completion of the office visit. In addition to reading to the children, students used grant monies to purchase books used in this program.

* "Neat Feet". In this program at a homeless soup kitchen, students used grant monies to purchase socks and foot powder and assembled the purchased items in an attractive gift bag. Students assisted a public health nurse at this site with foot soaks and foot assessments. Gift bags were distributed to the participants at the completion of the nursing assessment.

* "Youth Education Explosion". This is a day long summer event that targets youth aged 12-18 and their parents for abstinence education and related youth development issues related to risk taking behaviors, such as drugs and alcohol. Students assist public health nurses and community health outreach workers in registration, facilitating traffic flow and assuring that the youth and parents are in their appropriate rooms for workshop presentations, distributing lunches, and collecting evaluation surveys at the completion of the event.

* Field services. These activities include health fair events, University blood drives, community "back to school" nights and outreach activities related to the nurse managed health center. Students assist public health nurses and other nursing center staff in a variety of events, including blood pressure screening, health education, and distributing handouts related to heart disease, immunization, lead poisoning prevention and cancer screening.

Student Reflections

A cornerstone of service-learning to have students analyze their CSL experience in relation to their values, attitudes, and goals, most often via journal entries. A written assignment can be a powerful way for students to clarify their values. In the health science courses, students can select a reflection activity that enables them to analyze their CSL experience and meet their personal need for expression. Students may do journal entries, write a narrative statement, compose a poem, or create art work in the form of a poster or some other artistic expression.

No matter what form the reflection activity takes, it is imperative that instructors ask students about their personal lessons learned along the way as well as the challenges encountered during the CSL activity. Students have often reported initial feelings of frustration and sometimes-even dismay, but over time have shifted their focus to the mutual benefits revealed to both the student and the recipient of the service activity. Some reflective statements by students in the health science courses are: "Now I can see how hard it is for a parent to take a sick child to an office visit when they have to bring along two other small children on the bus with them"; "it is really awesome what impact I think I made on these people today and I plan to continue with this activity on a monthly basis, and more during the summer"; "before I took this course I did not know much about nursing centers and now I know how necessary they are in urban areas today" and " I plan to continue working at the soup kitchen and taking my daughter with me." Challenges encountered during the CSL activity are primarily related to time constraints due to family and work responsibilities as well as transportation issues.

Strengths and Challenges

The strength of these CSL experiences is the mutuality that the experience can bring to the community, students and academia. To implement valid CSL experiences, partnerships with schools of nursing or nurse managed health centers are one approach that can be utilized by academic settings regardless of geographic locale. Students of all disciplines require mentoring to develop critical thinking skills focusing on civic and social responsibility. Faculty who engage and mentor students in CSL experiences need to be encouraged to share their expertise with their colleagues. Evaluation methodologies must be developed to demonstrate the impact of the CSL experience on students, faculty, staff and the community at large. To meet the mission of the university in 21st century society, CSL experiences, as described in this essay, can be replicated in other academic settings throughout the nation.

References

Eyler, Janet and Giles, Dwight, E. Where's the Learning in Service Learning. San Francisco, CA: Jossey Bass, 1999.

Kinsey, Katherine and Buchanon, Marjorie "The Nursing Center: A Model of Community Oriented Nursing Practice.'" In Marcia Stanhope and Jeanette Lancaster, Eds. Community and Public Health Nursing, Chapt 18. Saint Louis MI: Mosby, 2004.

La Salle University (2005a). Retrieved February 26, 2006, from http://www.lasalle.edu/mission

La Salle University (2005b). Retrieved February 26, 2006, from http://www/lasalle.edu/students/dean/mission

La Salle University (2005c). Retrieved February 26, 2006, from http://www.lasalle.edu/academ/nursing/undergrad/phil.htm

La Salle University (2005d). Retrieved February 26, 2006, from http://www.lasalle.edu/academ/nursing

National Service Learning Clearinghouse (n.d.) Retrieved March 7, 2006, from. http://www.servicelearning.org

Sigmon, Robert. "Serving to Learn, Learning to Serve." In Linking Service with Learning. Washington DC: Council of Independent Colleges, (1994).

Mary Ellen Miller La Salle University, PA

Louise Giugliano, La Salle University, PA

Miller, MSN, is Assistant Professor and Associate Director of Public Health Programs and Giugliano, MA, is Associate Director of University Ministry and Service and Coordinator of Community Service and Learning