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Linking Classroom Learning to theCommunity Through Service LearningMary Ellen Trail Ross DrPH MSN RN GCNS-BC aa University of Texas Health Science Center at Houston (UTHealth),School of Nursing , Houston , Texas , USAPublished online: 07 Feb 2012.

To cite this article: Mary Ellen Trail Ross DrPH MSN RN GCNS-BC (2012) Linking Classroom Learning tothe Community Through Service Learning, Journal of Community Health Nursing, 29:1, 53-60, DOI:10.1080/07370016.2012.645746

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Journal of Community Health Nursing, 29: 53–60, 2012Copyright © Taylor & Francis Group, LLCISSN: 0737-0016 print / 1532-7655 onlineDOI: 10.1080/07370016.2012.645746

Linking Classroom Learning to the Community ThroughService Learning

Mary Ellen Trail Ross, DrPH, MSN, RN, GCNS-BCUniversity of Texas Health Science Center at Houston (UTHealth),

School of Nursing, Houston, Texas

Service learning is valued as a means of providing education to students and service to the community.The purpose of this article is to describe the incorporation of service learning in an undergraduatebaccalaureate level Gerontology nursing course. Details of the service learning experience, commu-nity agency partnership, the students’ reflections, evaluations from both the students and communityagency staff, and faculty challenges are presented. This information may be useful to others whoare considering service learning as a strategy for educating students while providing service to thecommunity.

Service learning, a concept that is becoming increasingly common in nursing education, is clearlyvalued as a means of providing education to all involved, as well as service to the commu-nity. A number of organizations support service learning. As far back as 1999, the AmericanAssociation of Colleges of Nursing identified the need for integrating service and communityinto mission statements of schools of nursing, as well as the importance of including community-based research and service in nursing education. One of the recommendations of the Pew HealthProfessions Commission (1998), as stated in a document entitled Recreating Health ProfessionalPractice for a New Century, is that health professional programs should require a significantamount of work in community service settings as a requirement of graduation and this workshould be integrated into the curriculum.” Furthermore, the American Association of Colleges ofNursing (2005) position statement, Nursing Education’s Agenda for the 21st Century, encouragesnurses in education and practice settings to use collaborative problem solving that integrates theconcepts of service and community to promote health.

DEFINITION OF SERVICE LEARNING

Service learning is defined as an experiential learning approach where the student works to meetthe needs of the community while addressing academic requirements (Cashman, Sarena, & Seifer,2008). Service learning is more than volunteerism because it connects academic coursework with

Address correspondence to Mary Ellen Trail Ross, The University of Texas Health Science Center at Houston(UTHealth), School of Nursing, 6901 Bertner, Houston, TX 77030. E-mail: Mary.E.Ross@uth.tmc.edu

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service to the community. Community is broadly defined and encompasses a variety of settings,including community agencies such as day care centers (pediatric and adult), nutrition sites,respite programs, schools, public health agencies, clinics, and hospitals (Hoebeke, McCullough,Cagle, & St. Clair, 2009). According to Kaye (2004, p. 7), “When service learning is used in astructured way that connects classroom content, literature, and skills to community needs, stu-dents will apply academic, social, and personal skills to improve the community and grow asindividuals, gain respect for peers, and increase civic participation.”

There are four characteristics or common themes that describe service learning: (a) Servicelearning addresses academic goals and objectives while meeting community needs; (b) servicelearning is reciprocal in that the service provided allows for learning by all involved in the expe-rience (student participants, staff, and stakeholders); (c) students are required to critically reflecton their service and learning experience through writing, discussion, journalism, or presentation;and (d) service learning requires the integral involvement of community partners and empha-sis on addressing community needs and concerns (Jacoby, 1996). Kaye (2004, p. 12) stated,“Reciprocity is the mutual exchange of information, ideas, and skills among all participants inthe learning and service experience.” Therefore, both the student and community benefit. Thestudents learn from the community agency staff who assumes a teaching role while addressingthe needs of the population they serve. The academic institution also benefits through the collab-oration and contacts it makes with community partners. The agency benefits from the satisfactionand enjoyment their participants/clients receive, the assistance the students provide, and the affil-iation with the academic institution. The purpose of this article is to describe a successful servicelearning experience for undergraduate nursing students in a community setting.

SERVICE LEARNING IN A BACCALAUREATE GERONTOLOGY COURSE

Students complete service learning hours in a required two-credit, junior level gerontologycourse taken in the second semester of the undergraduate baccalaureate degree program at TheUniversity of Texas Health Science Center at Houston (UTHealth) School of Nursing. The under-graduate gerontology course is designed to explore current issues and concepts related to aging.Concepts such as attitudes about aging, health, culture, safety, economics, ethical/legal issues,and environment are addressed. The overall goal of the course is to facilitate students’ under-standing of older persons and their unique needs, so that they are prepared to provide holisticcare and foster a better quality of life for the elderly population.

A total of 8 hrs. each of service learning is required in the community setting. Specific courseobjectives related to the service learning experience are that students will participate in servicelearning activities at the community agency, communicate with and assist older adults, and gaina better understanding of the health and functional status, needs, and concerns of older adults.Second, students are to observe the roles of the registered nurse and other staff members at theservice learning community site.

One of the advantages of this course is that students interact with older adults along a con-tinuum ranging from well elders to nursing home residents. In addition to the service learningrequirement for this course, students perform functional assessments of older adults in acute caresettings in collaboration with a medical-surgical course taught concurrently with the gerontologycourse. Students also interview well elders who reside in a continuing care retirement community

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about various topics such as health maintenance, medications, and nutrition. Last, the studentsperform functional assessments on nursing home residents. During their experience on the long-term care unit, they are exposed to the minimum data set, a federally mandated assessment forlong term care and skilled nursing facilities.

COMMUNITY AGENCY PARTNERSHIP

The community agency that partners with the gerontology faculty to facilitate this experienceis Sheltering Arms Senior Services—Adult Day Center. The day center is state licensed anddesigned for adults who have Alzheimers disease or other forms of dementia and memory loss.The day center has been open since 1987 and provided the first dementia-specific day center pro-gram in Houston, TX. The mission and goal are to provide caring supervision and enjoyable recre-ation for those with Alzheimer’s disease or other forms of dementia, promoting independence andimproving participants and their family’s quality of life. Some of the activities the agency pro-vides include crafts, exercise, memory games, bingo, dancing, and reminiscence. Staff membersare trained to care for those with Alzheimers disease and other types of memory loss. The staffconsists of a director, a registered nurse consultant who is available 2 days a week to addresshealth care concerns, oversee documentation, and review state regulations, a licensed vocationalnurse who is available throughout the day for care planning and supervision/administration ofmedications, an activity coordinator, and many certified nursing assistants who run the dailyactivities/programs and provide care. Volunteers are always welcome. The age of the partici-pants range from early 50s to 100 years old and, as mentioned, participants must have some formof dementia or memory loss. Approximately 50–65 residents participate daily.

SERVICE LEARNING EXPERIENCE

In the Spring 2009, 76 undergraduate student nurses completed 8 hrs. each of service learningat Sheltering Arms Day Center. This service learning assignment addressed course objectives inthe junior level gerontology course as noted earlier. The staff welcomed students and instructedthem on how they could participate and assist with implementation of the different programsand activities for the day. Prior to departing the facility, the students were required to obtain thesignature of the registered nurse on their verification form. This form verified the date and amountof time that the student spent at the facility and was submitted to the course faculty.

REFLECTIONS ON SERVICE LEARNING

One of the characteristics of service learning is that students are provided time to critically reflecton their service and the learning experience. Reflection helps the student think about and analyzetheir experience in the context of their classroom learning and the needs of the elderly clientsserved by the community agency. According to Kaye (2004, p. 26), reflection is “indispens-able to the entire service learning process and is what weaves it all together intellectually andemotionally for everyone involved.” To meet this objective, students were required to reflect on

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their 8-hr service learning experience in a 2-page paper while addressing specific questions abouttheir 8-hr day of service learning. In the reflection paper, students are asked to describe: (a) thevarious types of activities provided by the community agency for participants as mentioned ear-lier; (b) the staff and their role; (c) the assistance provided by the student which involved assistingstaff and participants with activities; and (d) their (the student’s) observations about older adultparticipants’ health and functional status, needs, and concerns.

The students observed various levels of dementia and mild-to-moderate memory loss. Mostof the participants were ambulatory; however, some used assistive devices such as canes andwalkers. Students noted normal aging changes such as hearing and vision loss, skin changes,gait and balance issues, and delayed reaction time, etc. In addition, students were asked threereflection questions. The first reflection question asked about “ways that the service learningexperience made the course material relevant.” Many students stated that the interaction withAlzheimer’s and other dementia patients made it easier to understand the disease and what wasdiscussed in class. One student commented, “When you’re reading a book, you are only gettinga snapshot of a bigger picture. Actually going out and seeing or being able to recognize it bringsthe theory aspect to life.” Another student commented that “reading and actually experiencing isa big difference.”

Many students stated that they were able to see first-hand the aging-related physical, mental,and social changes that they learned about in class. Some of the specific examples mentioned werehearing loss, poor eyesight, diminished cognitive and physical abilities, and short-term memoryloss. One student shared that

One of the members mentioned to another member that when someone asks him a question about arecent event and he doesn’t remember, he feels better saying any response, as opposed to saying “Idon’t know.” This same member had full intact long-term memory—for we talked in detail about hisprevious employment.

The student commented that this situation helped her understanding of short- and long-term mem-ory loss. Another student shared that the most poignant example for her was when, after talkingto a very alert, delightful man at length, he proceeded to excuse himself to go upstairs wherehe was meeting his wife; however the student explained that there is no upstairs, and clients arealerted when family arrives. The student verbalized that this is when she surprisingly noticed thefirst signs of dementia. Furthermore, the student expressed, “Seeing this moment made me realizehow vague the symptoms of Alzheimer’s can be, yet so real.” Other statements about ways thatthe service learning experience made the course material relevant are presented in Table 1.

The second reflection question posed was: “What has been rewarding about your service learn-ing experience?” A majority of the students stated that the service learning experience was veryrewarding because it helped them understand Alzheimer’s disease and other types of dementia,as well as how to care for and communicate with clients with dementia. Many students stated thatthis was their first opportunity to interact with dementia patients and observe the different stages.Some commented that it was “eye-opening” to see the variability among the participants. Onestudent shared that “one man discussed his past life as if he had no memory impairment, whereasanother individual did not communicate well and gave only one word answers.” Other commentsshared by the students are listed in the second half of Table 1.

The third reflection question asked the students what they would change about the servicelearning experience that would make it more meaningful. The majority of the students stated they

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TABLE 1Student Identified Relevance of Service Learning

Opportunities provided by service learning:Implement communication techniques learned in classOvercome previous biases about the elderly populationInteract with variety of dementia patientsUnderstand caregiver role and associated stressesAppreciate the benefits of adult day care centers for older adults and caregiversAppreciate the inspiring, quality care provided by staff

Student identified rewards of service learningAfforded a broader view and understanding of the needs of the elderlyConversing and learning about the elders’ life experiences/storiesHands on experience; Volunteering and helping the communityHappiness and appreciativeness of older adult participants and staff

would not change anything. Many stated that this experience motivated them to provide volunteerhours when they have extra time, once the course is over, or after graduation. This is confirmed byGillis and MacLellen (2010, p. 1), who stated that “service learning prepares graduates to engagein continued citizenship throughout their careers.” Other comments were: provide another clinicalday at the facility to get to know the older adults better; stay until members leave to see how theyreact to loved ones picking them up, and present poster projects at the facility which would bebeneficial for members.

EVALUATION OF SERVICE LEARNING EXPERIENCE BY STUDENTS

The students were asked to complete a brief, anonymous evaluation of their service learningexperience and the agency using a slightly modified version of the service learning evaluationquestionnaire developed by Bender (2008). The questionnaire consists of eight questions basedon a Likert scale, and one yes/no question. All 76 of the students completed the first sevenquestions listed on the first page, and 74 students completed the additional two questions listedon the last page of the questionnaire. It’s possible that the two students unintentionally forgot todownload the second page of the questionnaire for completion. Overall, the students’ feedbackwas very positive as summarized in Table 2. Possible responses were excellent–poor (question#1), strongly agree–strongly disagree (questions #2–7), very satisfied–very dissatisfied (question#8), and yes/no (question #9).

EVALUATION OF SERVICE LEARNING BY COMMUNITY AGENCY STAFF

The community agency staff members were asked to complete a brief, anonymous, 10-item eval-uation of the students’ service learning experience using a service learning questionnaire andevaluation form developed by Bender (2008). A total of seven staff members ranging from theregistered nurse to certified nursing assistants completed the evaluation. Overall, the staff mem-bers’ feedback about the students was very positive, as noted in Table 3. Possible responses wereexcellent–poor (question #1) and strongly agree–strongly disagree (questions #2–6).

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TABLE 2Student Evaluation of Service Learning Experience

1. How would you rate the overall quality of yourservice learning experience?

Excellent – 57 (75%)Good – 17 (22%)Fair – 2

2. I have a better understanding of the needs of eldersand problems facing the community.

Strongly Agree – 53 (70%)Agree – 21 (28%)Disagree – 2

3. The service learning showed me how I can becomemore involved in my community.

Strongly Agree – 53 (70%)Agree – 22 (29%)Disagree – 1

4. The service I did through this course was beneficialto the community.

Strongly Agree – 51 (67%)Agree – 23 (30%)Disagree – 2

5. I will volunteer or participate in community servicein the future.

Strongly Agree – 38 (50%)Agree – 33 (43%)Disagree – 5 (7%)

6. Participating in the service learning component ofthis course has enhanced my understanding of thecourse content.

Strongly Agree – 43 (57%)Agree – 26 (34%)Disagree – 5 (7%)Strongly Disagree – 2 (2%)

7. The service learning assignment made me aware ofsome of my own biases.

Strongly Agree – 39 (51%)Agree – 29 (38%)Disagree – 7 (9%)

8. Please rate the following in terms of the serviceagency where you completed your service learning.

Strongly Disagree – 1

Helpfulness of the agency staff. Very Satisfied – 65 (88%)Satisfied – 12 (16%)

Adequate supervision. Very Satisfied – 62 (84%)Satisfied – 11 (15%)

Meaningful tasks to perform. Very Satisfied – 48 (65%)Satisfied – 21 (28%)Dissatisfied – 5 (7%)

Acceptance and support. Very Satisfied – 61 (82%)Satisfied – 12 (16%)Dissatisfied – 1 (1%)

Recognition of my efforts. Very Satisfied – 61 (82%)Satisfied – 11 (15%)Dissatisfied – 2 (3%)

9. Would you recommend the agency where you workedto students in the future?

Yes – 73 (99%)No – 1 (1%)

Note. Adapted from S. Bender (2008).

When questioned about what was accomplished by the students that couldn’t have been doneotherwise, staff members commented that the students were able to provide one-on-one attentionto participants, which helped them feel more special. One staff member commented that this one-on-one time with members who needed extra attention gave staff time to do other work whichneeded attending to. Some staff members commented about the learning students received aboutdementia, as well as the fun students told them they had working with dementia patients, which“doesn’t come from a book, but by hands-on experience.” One staff member stated that students

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TABLE 3Community Agency Assessment of Student Service Learning Experience

1. How would you rate the overall quality of the students’contributions?

Excellent – 3 (43%)Good – 2 (29%)Fair – 2 (29%)

2. Students had a positive impact on our organization’sefforts to meet the needs of the clients/participants.

Strongly Agree – 4 (57%)Agree – 3 (43%)

3. Students were sensitive to the diversity of ourclients/participants.

Strongly Agree – 5 (71%)Agree – 2 (29%)

4. Students were reliable as evidenced by follow through onscheduled hours and punctuality.

Strongly Agree – 5 (71%)Agree – 2 (29%)

5. Students had a positive attitude (cooperative; willing towork and learn).

Strongly Agree – 3 (43%)Agree – 3 (43%)Disagree – 1 (14%)

6. Students put forth effort to learn about the agency,activities, health, and functional status of the participants.

Strongly Agree – 3 (43%)Agree – 4 (57%)

Note. Adapted from S. Bender (2008).

brought new ideas that helped deal with issues they had been seeking answers to. Staff membersreported that the community site improved by students engaging the members in conversation.Some staff members commented that the students were cheerful and willing to fill in and it was achange of scenery to have younger faces assisting with activities, leading some of the programsand games, and helping members enjoy social time. An example given was that members like todance and the students provided more opportunities for them to get up and dance, which broughtmore smiles on their faces.

When asked about improvements that could be made on the part of the student nurses or theschool that would enhance the service leaning experience, the registered nurse commented that ittakes about an hour to conduct the orientation for the students and have them sign privacy formson each service learning day. She offered to host an orientation at the School of Nursing in theclassroom so that the students would only need a tour when they arrived. This was a very goodsuggestion that we are considering implementing in the future.

A couple of staff members commented that hands-on training about dementia and Alzheimer’sdisease is “always a plus, especially for first time helpers.” In addition, several staff membersreported that one group of students clustered and talked among themselves instead of withthe adult members. This may be one drawback of not having a faculty member in attendance.Additional comments were that, overall, the students were cheerful, helpful, asked questions, andhad a wonderful attitude and participation. Staff members appreciated the students’ presence andassistance and hoped that they would continue to visit. They commented that the service learn-ing experience taught the students about dementia and helped them learn about a disease thataffects many.

CHALLENGES FOR FACULTY

Although faculty are not present to directly supervise students during the service learning expe-rience, it is very time consuming to coordinate, set up, and arrange, particularly with large class

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sizes and use of various agencies. Occasionally there are schedule conflicts that arise with othercourses or student absences, which require cancellation and rescheduling with community agen-cies. In addition, faculty time is required to read student reflection papers and evaluation of theservice learning experience. This helps ensure that the objectives are met. Despite the time con-sumed, faculty members find that service learning is very beneficial to students, as well as thecommunity.

CONCLUSION

Service learning is a very useful teaching strategy that reinforces course content and increasesstudent learning while providing service to the community. Students overcome negative stereo-types and biases and develop greater sensitivity, empathy, and insight about the health, functionalstatus, and needs and concerns of older adults and their families. Through this experience, manystudents enthusiastically want to give back to the community. Acquired skills may empower stu-dents to become future advocates for vulnerable groups. In addition, this experience enablesnursing students to learn about different nursing roles in the community. Service learning alsoprovides visibility for the school and partnerships with the community. Communities can engagewith universities and schools of nursing to assist with meeting the needs of their elder participantswho are generally happy to have energetic, young people around.

REFERENCES

American Association of Colleges of Nursing (1999). The essential clinical resources for nursing’s academic mission.Washington, DC: Author.

American Association of Colleges of Nursing (2005). Nursing education’s agenda for the 21st century. Retrieved fromhttp://www.aacn.nche.edu/Publications/positions/nrsgedag.htm.

Bender, S. (2008). Service learning community manual. Rochester, NY: Center for Service Learning at MonroeCommunity College. Retrieved from http://www.mesacc.edu/other/engagement/SAFEProject/ServiceLearning-CommunityManual.pdf

Cashman, S., Sarena, D., & Seifer, D. (2008). Service-learning: An integral part of undergraduate public health. AmericanJournal of Preventive Medicine, 35, 273–278.

Gillis, A., & MacLellan, M. (2010). Service learning with vulnerable populations: Review of the literature. InternationalJournal of Nursing Education Scholarship, 7(1), 1–26.

Hoebeke, R., McCullough, J., Cagle, L., & St. Clair, J, (2009). Service learning education and practice partnerships inmaternal–infant health. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 38, 632–639.

Jacoby, B. (1996). Service-learning in higher education: Concepts and practice. San Francisco: Jossey-Bass.Kaye, C. B. (2004). The complete guide to service learning: Proven, practical ways to engage students in civic

responsibility, academic curriculum, and social action. Minneapolis, MN: Free Spirit.Pew Health Professions Commission. (1998). Recreating health professional practice for a new century. San Francisco,

CA: Center for Health Professions.

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