Kristen Rawlett Lecture: Service Learning in Nursing

Kristen Rawlett, PhD, of the University of Maryland, Baltimore, discusses service learning for nursing students at the Course Hero Nurse Educator Summit.

[transcript]

Kristen Rawlett: As you guys know, I’m going to be talking about service learning in nursing. And in talking with some of the other nursing symposium participants, and probably the ones that I haven’t had a chance to talk to in depth yet, I think pretty much all nursing programs have some level of service learning, right? We’re nurses; it’s what we do. What I’m going to talk about is some personal experience with service learning, and then also some different, kind of innovative ideas. And then at the end, what Alex alluded to, is we have some—a really cool interactive session, and we’re actually going to give you a take-home that you can use as a deliverable. So that way we’re not just pie-in-the-sky talking about ideas. It’s important to focus those ideas and bring them to fruition. You guys can have a pragmatic tool that you can take home with you and talk with your coworkers or faculty and say, “Hey, what about this?” Or, “How do we make it work for us?”

So the picture here is a group of them—CNL students. By a show of hands, and I imagine it’s going to be more the nursing faculty, what does CNL stand for? Does anybody …?

Audience: Certified Nurse Leader.

Rawlett: Certified Nurse Leader? Exactly. So basically, CNL students are getting their master’s degree, but they have an undergraduate degree in something else first. So it’s an accelerated degree program, but they are entry-level master’s students. So these are very highly educated nurses, but they’re entering the field for the very first time with a master’s degree. So, just to give you some background.

All right, so as far as the contents of the talk, talk about the definition of service learning just to make sure that everybody’s on the same page, and then I will highlight our specific event. And the great thing about teaching through experience—and I’ve talked to some people about this one in the last few hours that we’ve been here—but the great thing about teaching through experience is, it’s my experience and it’s what we did. And I’m pretty sure no one can raise their hand and be like, “No, you didn’t. No, that didn’t happen.” So it’s my experience, and it’s true and it’s valid and hopefully you can take a piece of it home with you or back to your schools and incorporate it. And that’s the great thing about teaching that way, because there’s no wrong or right answer. It’s an experience, and it’s valuable information.

So we’re going to talk about how the students learn, through debriefing after our event. And if you don’t know what debriefing is, we’ll talk—I’ll talk a little bit more about that, as well as the outcomes, because we all know we have to have deliverables in any profession, right? Something to measure what we’ve done. And the effects, because this is a nursing education–focused event. We’ll first talk about the effects on students. And then I didn’t want to leave out the effects on the community partners, because if you don’t take into account and acknowledge the community partners and actually sometimes let them take the lead, you’re not going to have a successful event, and it’s certainly not going to be sustainable.

So as far as a definition, I am not one to read from the PowerPoint. These are long and boring, but basically it’s an educational approach that combines taking students—for me it was taking students into the community to fulfill an actual need identified by the community. That was a valuable learning experience, more than just volunteering. It had a little bit more structure and purpose to it. It can apply to classroom learning for local agencies, so one way that you could do it in the classroom maybe is doing, like, gift bags or bags for homeless people, or writing cards for veterans. There’s things, compassion and culture and language, that you can teach through that. The event that I’m going to talk to you about is one where we actually went out into the community, which is probably more traditional when you think of service learning in nursing.

All right, so you will notice throughout the program that I don’t have any pictures of the participants. We were actually at a middle school in West Baltimore, and I mean, I know the news made it over here. This is the same neighborhood where the Freddie Gray uprising happened, so it is known nationally. It’s an underserved area with a vulnerable population, and unfortunately there are a lot of unmet needs there. So in a way, pretty much anything that we went in and did with this community, partnering with them was going to be seen as beneficial. So actively engaging nurses, refining cultural consciousness—again, this is of the nursing students—and using individual coursework. I’m also looking at health at the population level, which is really a buzzword, and then looking at the healthcare system as well.

OK. So for our event, it was actually funded by AACN [American Association of Colleges of Nursing] and NIH [National Institutes of Health], and it was called Improving Health for All of Us in Baltimore and Beyond. For those of you who haven’t of it, it’s a national initiative for precision medicine by NIH. So basically what this is saying is, we have lots of data and research on Caucasian men as far as how to treat high blood pressure, for example. But if I see a patient in clinic who’s a Hispanic female, the medicine that works on a 50-year-old Caucasian male may not work as good on a young Hispanic female. So. But what we need to gather that information is research, and for people to participate in research. To clarify, this service-learning event was not research. It was education about research. Why should you participate? What does it mean? How can it benefit you and your community?

So I received this funding, and then I had to implement the event, and that’s when we offered the opportunity for nursing students to partner with us for service learning. So we actually went to the school, the middle school, to partner with them and offer this educational event. We were very purposeful about [it]; we didn’t want it to be on the university grounds or campus, because we wanted to bring the information to the community. So we went to a middle school and we asked them what format they would prefer, as far as what’s going to speak to your community best. I don’t live in West Baltimore, I’m not from West Baltimore. I don’t pretend to assume that I know how they learn or accept people from outside the community the best. So the school has a community outreach coordinator as well as talking with different stakeholders and leaders.

And what they picked was an interactive town hall. And the reason we did an interactive town hall is because, much like our nursing students, the community members did not want to be spoken to. They wanted to speak with the nursing students, faculty, whoever was going to be doing this interactive town hall. And they were very particular that they wanted the opportunity to ask questions. That’s how we marketed it, and we included faculty, students, and community partners. And of course we had to have faculty to be able to supervise the students. And the community partner’s role was to inform what activities we did and how we presented the content. So the event basically facilitated the nursing student’s ability to participate in service learning. Basically we gave them an opportunity. This was not a required part of a course. It was not graded. It was basically a volunteer opportunity that the students could do.

And we labeled it as a way for them to develop cultural consciousness outside of a traditional classroom. So that’s the big take-home for this service learning, and most service-learning experiences, right? So I can take a textbook or even a YouTube video, and I can tell you about cultural consciousness. I can define it; I can show you a video of it, maybe. But until you’re embedded in a room of people who look nothing like you, or don’t speak like you or whatever the example is, it’s very difficult to learn. So experiential learning is really beneficial for this content. And while I had funding, and while I had nursing students that were willing to come alongside me and do this, we kind of turned this educational opportunity into what I would call a living lab, so to speak.

OK. So before we get to the—the learning through debriefing happens after the event. So the only other thing that I wanted to say was that at the University of Maryland, we have a simulation lab. So we do a lot of learning, and that is a level of experiential learning. But I can’t—I couldn’t recreate this in a lab. I couldn’t train an actor or an actress to do this, because this immerses the students in the neighborhood with the row homes that have a blue tarp over them but there’re still people living there. It embedded the students in a school where 100% of the children that attend there receive lunches because of the socioeconomic status of the neighborhood, and embedded students in an environment where there’s a high level of violence and distrust for outsiders. So, and again, it was a wonderful experience and it was wonderful for the community to let us in.

And it’s a little bit of … how do I say this? Unpredictableness that you have to be prepared for. So you have to let the students know that ahead of time. And you also have to have the right faculty, because you can’t go into this experience knowing exactly how it’s going to go, right? You don’t know exactly what questions the community is going to ask or—I don’t know, you just have to be prepared for the unprepared, be flexible, and it’ll go just fine. And this one did, luckily. So basically the nursing students helped with questionnaires with the educational event. I’m not going to go in detail about the event itself. I didn’t get pictures of the students actually doing the event, because with a lot of the children and families that involved consent to get their picture, so out of respect for the community, I did not include any of these in there, but basically the students were interactive with other participants.

There were students sitting next to community members. Some students helped watch the children or engage them in games so that the parents could interact in the town hall. They answered health-related questions that the participants might have. We had some students, when they realized they were nursing students there, ask how they became a nurse. Those sorts of things. Just an exposure to the community and a way for the university to say we were here in a way that that community isn’t used to always receiving. Also, giving the community the reins as far as, “You take the lead and you tell us what date you want it, what time you want it, what outcomes do you want as a community.” And then also, how do we give them the results from the town hall. And we went to the community outreach coordinator and she asked, basically, the members of the school, “How do you want the results?”

And they ended up via newsletter, something that they could easily beam out to everyone, is what they wanted. But do you see how with service learning, by no means did I come as a PhD-prepared nurse to this poor, underserved community and say, “You know what, I’m going to do this for your community and it’s going to be the best thing ever.” Because it would not have been successful, because it’s not meaningful to them.

So I would say probably about a year before you plan on doing a true service-learning activity is when you need to start partnering and exploring options with the community. And you can’t go in with a mindset of, “Oh, my students need to learn how to take blood pressure, so we’re going to do a blood pressure screening.” Because you’ve already biased your activity. So as best you can—now, we all know as educators we have essentials that we need to follow and certain guidelines and things that we need to teach. But I would say, before you decide what students you’re going to invite or what course you’re going to incorporate it in, go to the community first, see what their needs are, and then know your courses or your faculty well enough that you approach them and say, “Hey, you know what? They need sports physicals in this school here. Do you have students that can provide that?” And that’s going to give you a much higher success rate for the community as well as your students.

So as far as, what was the students’ learning experience? We did do a debriefing session. I actually had the students put it in writing, as well as I’m talking with them individually and as a group. And I felt like putting it in writing gave them a chance to do a little bit of journaling, because some of them needed to decompress.

It was a very positive experience, but it’s a lot of activity and adrenaline, and then all of a sudden it’s over and you go home and you’re like, “OK, how do I unpack that?” So the students reported very positive personal experiences, as far as many of them said they would have done it even it wasn’t something for school or required. And the same feedback has happened with similar events that I’ve done. I have specific quotes from the students, but because we’re skimming the surface and we have an activity at the end of this, I’d be more than happy to email or provide that to people if they want to hear some of the students’ voices.

They articulated being informed on the importance of precision medicine and gaining community trust in the conduct of research or teaching about research. So, even though we were there to teach the community about the importance of precision medicine, guess what? The nursing students had to be resourceful and competent on what precision medicine was in order to interact with the community. So we had a speaker from AACN actually giving the talk from AACN and NIH, that was a very structured and specific about what he had to say. But the students had to have a baseline knowledge beforehand in order to interact with the community.

So the educational activity provided opportunities to practice communication and leadership skills in a community like West Baltimore, which, again, is not always open to outsiders. So how do you talk with children? Right? Some of these nursing students maybe are studying to be adult health nursing students or ICU nursing students. And while we all have a required bit of pediatric exposure to go through rotations through our programs, many of them weren’t comfortable talking with children, or just hadn’t had a lot of opportunity outside of clinical practice.

So working on talking with a seven-year-old versus talking with a 70-year-old is quite different. And you might think that nurses and nursing students are very proficient with that, but…. We get there, but it takes practice, believe it or not. So that was a great learning experience. And again, these are the things that the students communicated to us along the way.

And then it inspired students to pursue solutions unique to underserved populations. Kind of like what I said earlier: It’s nurses, it’s what we do. A lot of times, when providers are limited or access to healthcare is not there, it’s the nurses and the nurse practitioners that are willing to go into communities that are not the most popular or not the most desirable, or even international environments. So I was really happy that the students picked up on that. And there might be a little bias—I don’t know if it’s because we’ve threaded that through their program at the university, or is that their heart and it’s coming out and that’s why they’re in our program at the university. But it was a nice outcome.

So what did we see as far as outcomes? The students adapted to the beat to meet the challenges by remaining flexible. Again, unless I picked you guys all up and teleported you to that neighborhood in West Baltimore—just like I said before, I can tell you and I can show you pictures, but unless you experience it, it was really unique to see how the students responded. And they really stepped up in a safe environment supervised by their faculty.

So I’m thinking, you know what: One of those students is maybe an ICU nurse and something comes up and it’s not the exact same environment, but we’re teaching critical thinking skills that aren’t specific to one environment or one population. And I was talking to someone else at the symposium earlier today and I said, “You know what? I can’t teach a student every single clinical situation that they’re going to come across ever in their career. It’s just not possible.”

So that’s when those critical thinking skills, clinical reasoning skills—I think someone said earlier that we really need to teach our nursing students, as far as you can’t depend on me, it’s got to be self-initiated—but we can plant those seeds. And we did see some of that here. The town event was perceived as providing a positive footprint in an underserved community, focused on the needs of the community. Score one for the university, right? We need to have a better reputation as far as embracing these communities and not just going to them for research participants. And I imagine the residents of West Baltimore are probably thinking, “If one more person comes to me to consent for a research study from Johns Hopkins or University of Maryland, I’m going to throw up,” and I don’t blame them. So again, we need to be able to give to the community and provide something valuable, because it’s a partnership; it’s not one-way. So the university was very happy with this, needless to say.

And most importantly, the participants were engaged in asking meaningful questions. So when we got finished talking about the education, with the town hall, one of the questions that someone asked—and I really applaud her—she said, “So you guys are going to want me to take medicine that you have no idea how it’s going to affect me?” Well, no, of course not, but that was her question. And it gave us a chance to revisit that and talk to the whole community about what we were doing or what we were hoping to do.

So again, the effects on students being an active participant, seeing a bigger picture of the world than just the corner they live in—I’ve talked about that already. Students felt good about helping others. Well, don’t we all? I think that’s by design, right? It makes you feel good that you’re contributing and actually doing something positive. And these students just happened to be getting some course credit for it as well. But I think that’s the thing that you’re going to be most successful at, when you enjoy [it] anyway. Provided diverse experiences, focusing on the unique needs of community members, and opportunities to learn individual and structural-level determinants of health. There’s another word, another buzzword, that people are always talking about.

Exploring health disparities: Even in this short two-hour town hall event, it spurred discussions and interest that weren’t there before, and cultural consciousness. Again, we’ve already talked about how it helped students see outside the box of the world that they live in.

Effects on community partners: I did have a strategic picture where everyone’s—you can’t identify any specific faces, but this is where we had the talk. There’s the speaker and the different slides that he was going through, but I think I’ve already touched on the effects for community partners. They valued the fact that we went to them first before we actually [said], “Oh, here’s the event that we want to do.” Also, I want to say a large percentage—I don’t have an exact number—of the funding that we received was poured into the community. So as far as food and resources, we were able to get transportation to the event, we didn’t want to tax the community in any way. So they really enjoyed the fact that we got to love on them and lift up the community and provide some fun stuff for them along the way.

OK. So I have no idea as far as time, but I think this is a good transition as far as our breakdown sessions. And let me explain this to you really quick, and then Alex can fill in anything that we’re missing. And if you guys have any questions, either about the presentation or about this, then maybe we’ll pause while people are moving around and you can ask questions, or you can find me later and I’ll be happy to [answer] that for you.

So one of the things that Alex and I wanted to do is provide some structure as far as: OK, service learning is not a difficult concept. But how do we give somebody who attended the symposium today some structure and say, you know what, I want to implement more service learning on a formal level at my institution but I don’t know how to do it, or I need just some simple structure.

So Alex actually came up with this form and I think you have the paper copies? OK. He’ll have—he’ll distribute those for when we do the breakout session. But basically what we’re going to have you guys do is work—and probably in the tables that you’re at, is why they have you with staff and faculty together—and you guys are going to come up with a service-learning experience that you can bring either to your home institution or for the Course Hero faculty.

You’re the community members, and we want your input to the faculty as far as, “That would be meaningful to me” or “I don’t know why you would do it that way, because I would never come to something like that.” Even though we’re all from different backgrounds, different communities, I want you guys to come up with one, two, three, four, five, six, or seven different sheets of paper. And then at the end of the time, what we’d like to do is have one person [give] just a quick three-minute presentation as far as, “This is what we came up with.”

So we might have three that look very similar. We might have five that are all very different. We’ll see how it goes. So, who would be a good community partner for nursing students? And again, this isn’t just for the nursing people. I want to hear from the Course Hero faculty or Course Hero staff as well. What could this partner/experience-ship look like in practice, and describe the activity. It doesn’t have to be detailed. It’s fine. How does the community benefit? How do students benefit? You heard some of my examples in the lecture. And then—this is something that I touched on in the lecture, but—what assignment can students produce at the end of the experience to reinforce the learning? You guys remember what we did for my students? What did I say I did?

Audience: [Inaudible.]

Rawlett: Yes. So one person was listening. That’s awesome. Yes, so journaling is an example. So if—and just in case that question throws anyone—but, so now none of you can use journaling. You can use journaling but you have to say journaling and something else. And then the other thing—now this would be more specific to the nursing faculty: If you want to add how you can tie one or two of the essentials from whatever program you’re teaching in back to this. Because if you want to add this to your curriculum formally, that’s probably the best practice to do that with. But I didn’t put that on here because everybody’s in different programs and places. So that’s something that the Course Hero faculty, you’ll have to consult the nursing people.

So that is service learning in a nutshell. And everyone’s like, “Oh, well, that was easy.” So now you guys get to do it and design your perfect event. And at this point I’ll take any questions as far as the talk or the activity. Alex, did you have anything else?

Alex Witkowski: No, the only thing I was going to suggest is—and we’re going to break off into the activity, and Kristen and I will be roaming around to see if we can be of any help. But it would be really awesome if the educators wouldn’t mind maybe providing the Course Hero—the people surrounding you from Course Hero a little bit of background on what exactly it is that you’re teaching at your institutions, because then hopefully the discussion can be catered towards what needs your students have and the types of classes that you teach. And I know Kristen alluded to that, but if we could start off on that, with that, that would be awesome. So—and also it is a great way to get to know everyone. So, yes. So why don’t we start with that. We’ll break off in discussion. We’ll probably have about 15-ish minutes to do this, and then we’ll come back together.

[Lecture pauses for group discussion period.]

Rawlett: Hey, so I hate to interrupt all this good discussion. And it’s been really valuable just for me to walk around and listen to the conversations and see what you guys are writing. And the body language actually is really cool too, to see everybody leaning in and talking. Initially we had planned to have everybody present, but again, out of respect for time and keeping us on schedule, I do think that if you guys will—if you haven’t finished filling out your paper, please fill it out, because we will provide copies for everyone. So even if your group doesn’t present, the information will go out to everyone. But are there maybe two groups that are just really passionate about wanting to present, or want to talk about what they did? Maybe this group right here. I heard lots of good discussion. [Applause.] Alex will get you the mic—hold on just a sec.

Sydney: Now I got it. I can hold these two things. Oh, I’m Sydney. Hello, everyone. I’m part of the Student Community team at Course Hero. So what we wanted to do is, we wanted to connect Course Hero and nursing students in the area, and then also with our volunteer program at Course Hero. We partner with a local middle school that is called KIPP, and we essentially, right now on a monthly basis, host different activities at KIPP for the after-school programs. In the past we’ve done science education or science activities, we’ve done video game activity or activities, et cetera. And it’s like a reward for the students: If they’ve done well in their classes, then they can come to this after-school activity that we help host.

So we thought it’d be awesome to connect nursing students with this community partnership that we already do. So what we would like to do first, of course, we would assess the need of KIPP and ask them, “What type of health education would you be interested in?” And having nurses potentially come in and help with that education. We thought that maybe nutrition for middle schoolers, let’s say, would be something that would be good to talk about at the school, and have some type of activity where we’re teaching nutrition in a fun way. So again, we would make sure that this aligns with the community, and we’d talk to them about what they actually think would be the best way for this to happen.

But let’s say that we were going to create, potentially, a game. So it’s like we could use—leverage Course Hero’s engineers to create a fun nutritional game—or a game that teaches nutrition. And so we had the Course Hero engineers partner with the nursing students to figure out exactly what that would look like, and have the nursing students help us assess what the need would be at this middle school. And then having us go into the middle school and having the nurses and the Course Hero people and the middle schoolers interacting together to go through this game activity. And maybe they could help us with different aspects of the game, and create a game that is for themselves, that in the end maybe potentially shows them, like, what they could be eating that’s good. [Laughter.]

So how does this benefit the community? Nutritional education. How does this benefit the nursing students? They can learn about how to talk about food and nutrition with probably a different audience than they’re used to, which would be younger children. And then also practice their communication skills. And then, what assessment can students produce at the end of the experience? Potentially we were talking about having this be an activity where they follow up with the community afterwards, so it’s not just a one-and-done activity. So that can reinforce learning for the nursing students through the repeated experience. And so we could have a feedback survey after each activity so that they can give feedback on how to improve next time. Yes.

Rawlett: Awesome. Any quick questions or comments about this group? That’s excellent.

Audience: [Inaudible.]

Rawlett: Yes, right.

Witkowski: Do you maybe want to do one more?

Rawlett: Go ahead.

Katie: Hi, everyone. My name’s Katie. I’m on the Marketing team. I’m thrilled to have everyone here. So, thanks so much for coming out. So our group took inspiration from Marcia’s school and community to focus on a rural, smaller community that—one of their limitations or struggles could be access or widespread knowledge about when to go to the doctor. What is it when you’re sick and when should you seek out help? So in these super tight-knit communities, people come together around schools, churches, community centers. So [the] idea was to host an event at one of those local community centers and actually bring in leaders, so people who maybe are often interacting with individual families. So it could be a leader at the church or a leader at schools, teachers. Things like that, where they actually are someone who people often seek advice from and can help disseminate this after the program. To have a discussion where they share, “What are the health challenges that you see in the community? What do you want to know more of?” Like, what can we supply that’s helpful. And then also make sure people feel really comfortable that it’s OK to share health issues and to ask these questions, that it’s encouraged, and not something that you should keep private. And be comfortable with them.

[The] community benefits from knowing about all these things and having information about preventative health care, things like: Go get a checkup every six months. Those things that may not be top of mind, and how to get access to that.

Students are benefiting from engaging with their community and teaching about access, learning, new perspectives, communication experience with different individuals.

And then one idea for an assignment would be to actually pass out a pamphlet or a laminated one-pager that they could keep next to the fridge or keep somewhere that has sort of the high-level, “Feel like this? Do this.” Like, “Have you gotten your checkup this year? Yes. No.” Like, how to do that. Maybe information about healthcare where you can go to get free services and just make sure that that’s distributed out to the community.

Rawlett: Awesome. So what are the first things that came to mind when I heard you say the first couple of sentences? How do I teach my nursing students clinical preventative guidelines without them just reading the manual and being like, “OK, you need to get cancer screening for this, and your blood pressure should be….” What a great way to make it come to life for the students. And they’re going to look back and remember that when they’re taking that NCLEX exam. And then the community is going to benefit, like you said, from having that information.

So here’s the other thing: You can turn anything into service learning. I think that is what we’ve learned. Those are really interesting examples, and I have no doubt that every table had something just as valuable and as interesting. So I appreciate you guys sharing, and thank you for playing along.

[Applause.]