Using technology to enhance service-learning reflections.

Abstract

The purpose is to describe a 15-hour classroom and web-based service-learning intervention offered Fall, 2002 to volunteer registered nurses studying for advanced degrees in a publicly supported university located in Manhattan, New York. Students were enrolled in at least one of two different theory courses that required a clinical practicum experience in a community setting. By using in-person and web-based strategies, students who were new to the use of technology, could be coached and encouraged to reflect on their clinical experiences using service-learning as an organizing framework.

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Service-learning has been described as structured learning experiences with a balance of service and learning that combines community service with explicit learning objectives with an emphasis on critical reflection about the service work and its relationship to professional education (Gelmon, Holland, & Shinnamon, 1998). The foundation of service-learning is a balanced partnership between communities and health professions schools and a balance between serving the community and meeting defined objectives (Seifer, 1998. Service-learning in nursing education is a curricular strategy for preparing nursing students for their roles as nurses and citizens, changing the way faculty teach, changing the way nursing education programs relate to their communities, enabling community organizations and community members to play significant roles in how nurses are educated, and enhancing community capacity to improve health (CCPH, 2000). The service-learning model fosters critical thinking and builds civic and social responsibility within a democratic framework.

Service-learning must: a) be experiential in nature; b) provide opportunities for students to engage in activities that address human and community needs via structured opportunities for learning; c) incorporate reflection; and d) embrace the concept of reciprocity between the service-learning and the person being served (Bailey, Carpenter, & Harrington, 2002). Reflection enables the student to make connections between service learning in the community and their learning experiences in the academic setting along with the opportunity to examine their attitude and value systems in relation to others (Bailey, 1999). Reflection also helps students to discover for themselves how the lessons of their service learning experience can be applied on a broader, deeper and more conscious level (Miller, 2001). The purpose of this article is to describe a 15 hour classroom and web based service-learning intervention offered during Fall 2002 to volunteer registered nurses who were studying for advanced degrees in a publicly supported university located in an urban setting.

Human Subjects Considerations

The research project: Impact of Service-Learning on Cultural Competency, Critical Thinking, and Civic Engagement was approved by the Hunter College Committee for the Protection of Human Subjects. All participants gave written informed consent.

Recruitment

During the summer of 2002, letters were sent to all graduate nursing students and nurses with an associate degree in nursing who were enrolled in a baccalaureate nursing degree program who were enrolled in semester-long (15 weeks) theory courses that had a clinical practicum requirement. The number of clinical hours in these theory courses could range from 45 to 220 hours.

Sample

Six female students volunteered to participate in the research, 5 registered nurses working towards a bachelor degree in nursing and one was a graduate student in the dual degree Masters in Nursing/Masters in Public Health program. Five of the six reported their ethnicity as Black/African American. Their clinical practicum settings included social service agencies such as Senior Centers and a community-based organization that was a nutrition program for persons with HIV/AIDS.

Description of the Intervention

Introduction seminar (6 hours)

Since the courses in which the participants were enrolled did not integrate content about service-learning, an in-person 3-hour morning session was conducted consisting of lecture-discussion about the theory and principles of service-learning. During the luncheon break in a nearby restaurant, participants and the intervention team, who consisted of project faculty and a research assistant who was also a graduate nursing student in the community health nursing/public health degree, were encouraged to converse casually as well as share concerns about the community-based placements. This open exchange helped to create the beginning framework on which trust and support could be built. After lunch, the remaining two hours were used to practice use of the Blackboard 4.1 program in the computer lab. This time was essential since this technology was new and unchartered-waters for all but one of the participants.

Web-based component (7 hours)

The online component of the intervention using Blackboard was designed to provide each student the opportunity to engage in reflection through web journaling and responding to discussion questions. The web modality affords participants the means to control their learning environment in a way that is free from distraction and in a time and place that is most convenient. This process of monitoring personal reactions and thinking processes in a deliberate way is critical in service-learning. Each participant submitted a web journal entry after each clinical experience and at least one response to a posted Discussion Board question, of which there was a total of eight (Table 1). To encourage participation in the weekly threaded discussion, e-mail reminders were sent to each participant prior to the posted question. Once participants logged in, they were provided information and guidance through announcements. Discussion Board questions were posted one at a time at periodic intervals throughout the semester. See issue's website <http://rapidintellect.com/AEQweb/sum2003.htm>

Final seminar: in person (2 hours)

During this final two hour in-person component, participants participated in a focus group that addressed the questions described on Table 2.

Results

Four of the undergraduate students and the graduate student completed all of the requirements for the project (n=5); an 83% completion rate (n=5/6). One undergraduate student withdrew from the project soon after the initial seminar, citing overwhelming personal and academic responsibilities. Another undergraduate student fell behind in her participation due to lack of skill in working with computers. After approximately two hours of individual instruction in the use of Blackboard, basic computer software, and the Internet, she participated regularly and completed the project.

To create a community of scholarship and dialogue, participants were given on-going feedback and support whenever they submitted material. During the first three weeks, responses to the Discussion Board questions were slow to get started. Participants needed frequent email reminders that these questions had been posted and that replies were in order. The early responses were a mixture of relief of unfounded anxiety and fear since their clinical preceptors and clients had greeted most participants warmly. As the semester progressed, the participants became more actively engaged in the threaded discussions. They began to make astute observations about similar experiences in their assigned agencies and offered advice, guidance and support to one another. These shared moments allowed the participants to realize that they were not alone in their service-learning experience and helped them to openly examine their attitudes and competencies.

Web journaling presented more of a challenge than responding to the Discussion Board questions. The threaded discussion question offered a group activity for all participants to share while the web journals were individually accomplished and only shared with the intervention team, therefore requiring more individual effort and reflection. Although the intent of the web journal was to bring clarity to important issues, allow for a living record of the learning process and aid in written reflection (deAcosta, 1995), it sometimes created tension, fatigue and inconvenience. Participant early entries were very detailed and included lots of discussion on tasks accomplished. With the help of on-going feedback, the journal reflections increasingly demonstrated personal development, critical thinking and a transformed perspective. Miller (2001) suggests that journaling can actually accelerate the ability to cope with stressors and all of the participants shared their experiences of anxiety and uncertainty.

Barriers and Bridges Using Technology

The use of web-based technology was a mixed blessing for many. Although they had expressed excitement about learning the Blackboard 4.1 program during the first seminar, many confronted several challenges when they had to log-in and use the program. During the first weeks of the project it was necessary to extend the due dates for several of the Discussion Board questions due to low response. After extensions were made and Blackboard Announcements and Email Announcements were sent to the students, the number of responses increased to full participation by the extended date. Mid-way though the semester several students began submitting more than one response to the Discussion Board questions, responding to the research assistant's comments, and also to those posted by other students.

The students had not been informed about the total number of Discussion Board questions to which they would be required to respond nor were they given a schedule of due dates. Rather, the research assistant posted an announcement approximately every 2-3 weeks, declaring that a new Discussion Board question had been posted, along with the due date. Students were referred to the Discussion Board section of Blackboard for the complete question. Each student also received an email announcing the same.

Journal writing seemed to present more difficulties than answering the Discussion Board questions. Journal entries were to be written in Microsoft Word or a similar software program and sent in using the Digital Drop Box section of Blackboard. Many students had trouble submitting the journal entries, initially. For the most part, these difficulties were worked out through email directions given by the research assistant in response to queries sent by individuals in the first two weeks or so. Only one student, mentioned earlier, had continued difficulties, necessitating additional one-on-one instruction.

A second difficulty with the journal entries had to do with the number required. Many of the students started their clinical assignment later than others and one finished her assignment at least one month earlier than the others. Students also did not submit an entry if they missed a week at the clinical site due to site cancellation or personal illness. This meant that some students had a few more entries than others. Realizing this inconsistency, students were encouraged to submit an entry each week, regardless of whether they had gone to the clinical site. A reflection was suggested so that the participants could gain confidence in their writing and reflection process. However, this was not always successful. Not all participants felt motivated to reflect and write a journal entry if they did not have a clinical experience. Another inconsistency noted in the web journaling process was that there was no deadline for submission for journal submissions. This caused confusion among some participant leading to infrequency and inconsistency of journal entries. Though some students kept to a weekly submission day, others seemed to save up several entries, which they then submitted all at once. This made it difficult to track student's growth and may have hindered communication. Within the first few weeks, students were repeatedly encouraged to submit their journals early each week, preferably by Monday morning. However, many did not adhere to this. In the future, students should be given a time frame for submission of journal entries and Discussion Board submissions that is distributed in writing at the initial seminar.

The External Links section of Blackboard was used to direct students to Internet sources, which might be helpful in integrating Service Learning concepts to their clinical experience. Announcements via Blackboard and Email notices directed students to the External Links section where a description of the site was outlined and from which the Internet site could be connected. Students were encouraged to use these sites as references in responding to Discussion Board questions and formation of journal entries. This is one area that was not really emphasized during the initial seminar and used only sporadically during the semester. Since the students had a very positive response, greater use of this area in the future will be incorporated.

Summative evaluation

Results of the approximately eighty minutes evaluation session are presented in Table 2. Discussion questions developed by the Case Western Reserve University Frances Payne Bolton School of Nursing Curriculum and Faculty Development in Community-Based Care Qualitative Evaluation project (Narsavage, 2002) were used with permission along with project specific questions. Table 2 describes the focus group question along with summary responses.

See issue's website <http://rapidintellect.com/AEQweb/sum2003.htm>

Next steps

The challenges associated with using the Blackboard technology need to be addressed before all students are required to use this method to deliver essential content. The extent of nervousness experienced by seasoned registered nurses as they contemplated providing nursing services in a community-based setting will need to be anticipated by course faculty and additional supports explored. Although all of the students could have used the 15 intervention hours as part of their required clinical practicum hours, none chose to apply for those hours and instead volunteered this time in addition to the course requirements. A second group has been recruited to participate in the intervention that was modified based on the feedback from the first group. This pilot work assisted in identifying potential barriers to the integration of the service-learning model into nursing courses with clinical practicum requirements. Results from this work will inform and shape future strategies to integrate the service-learning model.

Note

This project was supported, in part, by the Building Community Partnerships Through Service-Learning grant from the Helene Fuld Health Trust, HSBC Bank USA, Trustee. The authors wish to thank the staff of Community-Campus Partnerships for Health for their continued support.

References

Bailey, P., Carpenter, D., & Harrington, P. (2002). Theoretical foundations of service-learning in nursing education. Journal of Nursing Education. 41(10), 433-436.

Bailey, P. Carpenter, D., & Harrington, P. (1999). Integrating Community Service into Education: A Guide to Service-Learning. New York: New York. Springer Publishing Company,. Inc.

Cohen, J. & Welch, l. (2002). Web Journaling: Using Information Technology to Teach Reflective Nursing Leadership Forum.6(4), 108-112.

Community-Campus Partnerships for Health (CCPH) (2000). Partnership Perspectives I (II), Summer.

DeAcosta, M. (1995). Journal writing in service-learning: Lessons from a mentoring project. Michigan Journal of Community Service Learning, 2 141-149.

Gelmon, S., Holland, B. & Shinnamon, A. (1998). Health Professions Schools in Service to the Nation: Final Evaluation Report. an Francisco:CA, Community -Campus Partnerships for Health.

Miller, S. (2001). Electronic Journaling: Using the Web-Based, Group Journal for Service Learning Reflection. Michigan Journal of Community Service Learning. 27-35.

Narsavage, G. (2002). Curriculum and Faculty Development in Community-based care grant. Email: August 2.

Seifer, S. (1998). Service-Learning: Community-Campus Partnerships for Health Professions Education. Academic Medicine. 73, 273-277.

Kathleen M. Nokes, Hunter College, CUNY 

Donna M. Nickitas, Hunter College, CUNY

Robin Keida, Hunter College, CUNY

Susan Neville, Hunter College, CUNY

Nokes, PhD, RN, FAAN is Professor and Project Director, Hunter-Bellevue School of Nursing. Nickitas, PhD, RN is Associate Professor. Keida, BSN, RN is Graduate Student. Neville, PhD, RN is Assistant Professor.