Caring for Our Community: Service Learning in the Nursing Curriculum
By Andrea Mengel, Independence Foundation Chair, and Barbara McLaughlin, Chair of the Department of Nursing—both of the Community College of Philadelphia
“How’s my blood pressure today?”
“Can you teach the children how to cross the street safely?”
“How can I exercise when I’m so unsteady on my feet?”
A Community College of Philadelphia nursing student teaches a local elementary school student about dental hygiene. (Photo by Dennis Gingell)
Every week, Community College of Philadelphia nursing students hear questions like these during their service-learning experience in the 19130 Zip Code.
Surrounding the college’s main campus in urban Philadelphia, the 19130 Zip Code community is distinguished by its racial and economic diversity. The community is comprised of approximately 50 percent white residents, 25 percent African American residents, 12 percent Asian residents, and 12 percent Hispanic residents. Living standards vary considerably: the average home price is $335,000, but 26 percent of the population lives below the federal poverty level. Like many neighborhoods in the United States, the 19130 Zip Code is experiencing economic and demographic change, with pockets of gentrification resulting in a decrease of the Hispanic population over the past sixteen years.
The college’s nursing student body is similarly diverse, comprised of approximately 50 percent white students, 30 percent African American students, and 20 percent Asian and other minority students. Most students receive financial aid and are from the Philadelphia area; 90 percent remain in the area after graduation. Service learning in the 19130 Zip Code prepares these students to become informed and concerned citizens able to meet the changing needs of their profession and their diverse community.
Faculty designed the 19130 Zip Code Project in 1996 to provide health promotion and disease prevention services to the community, and to prepare nursing students for post-graduation employment in a changing health care system. At the time, hospital-based health care dominated nursing education and the field of nursing itself. Faculty hoped to better prepare nursing graduates for employment in other settings by integrating community-based care into the nursing curriculum.
Faculty were also motivated by growing public concerns about the need for health promotion and disease prevention services for vulnerable populations. Then as now, the college’s mission included serving the community, and in the mid-1990s, the national movement to increase community-based health care was growing. Nevertheless, the decision to initiate community-based service learning was an extraordinary step at a time when community-based care was a hallmark of baccalaureate and graduate degree nursing programs, not of their associate degree counterparts.
Driven by these factors, faculty revised the nursing curriculum to better serve the community and the college’s students. By replacing hospital-based clinical experiences with community-based care, faculty responded to the community’s changing needs while enhancing students’ knowledge, skills, and employment opportunities.
In its current manifestation, the project requires second-year nursing students to provide a wide range of health promotion and disease prevention services to clients in a variety of community agencies located within the 19130 Zip Code. For their clinical experience in a required course, each student engages in a six-week experience at a single neighborhood agency, requiring twelve hours of weekly service. All students participate in these experiences, learning under faculty supervision to work independently and collaborate with agency staff to achieve mutually defined goals.
Community agencies serving vulnerable populations—including Head Start and preschool programs, public and parochial schools (K–12), and senior citizen housing and day care facilities—collaborate with nursing faculty and students to identify needed programs and services. After recruiting agencies to participate in the project, faculty work closely with agency staff to identify mission-based goals and activities that meet agency and student needs.
The project receives significant support from the Independence Foundation, a private, not-for-profit philanthropic organization serving Philadelphia and surrounding counties. The foundation provides the college with an annual grant of about $15,000 for the purchase of supplies such as blood pressure equipment, smoking cessation materials, nutrition teaching aids, safety coloring books, beer goggles to simulate alcohol intoxication, toothbrushes, audiometers, blood pressure equipment, and personal hygiene items.
Components of Service
Across agencies, students provide services characterized by ongoing assessment of the needs of individuals and families, sensitivity to cultural diversity, collaboration with faculty and staff, and a strong emphasis on health promotion. They conduct screenings for weight, vision, blood pressure, and height and also provide health education on topics including exercise, nutrition, home and street safety, prevention of sexually transmitted diseases, and hypertension management. While clients are of all ages and backgrounds, the majority are African American children due to the large number of schools participating in the project. (Significantly, many nursing students have conducted their service learning in schools they attended as children.)
The 19130 project is fully integrated into the nursing curriculum through pre- and post-service activities. All four courses in the nursing curriculum address concepts of community-based care, cultural competence, and interdisciplinary health care, with students learning about community needs through assignments such as interviews of elderly community members. Before beginning their service-learning experiences, students complete an analysis of socioeconomic and cultural aspects of the neighborhood using internet resources and direct observation. Following each day of service, students use a web-based tool to record data about the clients they served and the services they provided. They also submit qualitative data about their perceptions of the experience at the end of the service-learning assignment. Faculty draw on these aggregate data to illustrate the value of service-learning experiences when planning the curriculum, developing grants, and negotiating with prospective agency partners.
Through their service experiences, students gain broader perspectives of their clients’ lives. They learn to consider home and community environments when planning client care, whether discharging clients from the hospital, teaching clients about healthy practices, or helping clients access health resources. In the process, they address community needs and build excitement about giving back to their community. Even graduates who go on to work in hospital settings value the skills and enhanced understanding of their patients’ lives that they develop through the service-learning experience.
During the 2011 calendar year, approximately 9,400 individuals were served by 125 nursing students working under the direct supervision of nursing faculty. Students provided a total of 9,000 hours of service, extending the capacity of agencies to assist their clients. For example, in schools where health promotion goals had been secondary to the needs of sick children, nursing students teach about healthy living while nurses address those children’s immediate needs. Students in school-based placements also assist in reviewing immunization records and collecting missing information from families. In placements with government-supported housing communities, students work with older adults to ensure that their medications, which are often issued by multiple healthcare providers with little collaboration, will not interact detrimentally.
To date, more than 1,800 nursing students have participated in the 19130 Zip Code Project. These students have gained valuable preparation for community-based care opportunities, which have grown to exceed career opportunities in hospitals. Having developed a broad range of skills, Community College of Philadelphia graduates are well prepared for these positions. In addition, they have developed a clear understanding of community while learning to value diversity and collaborate on the behalf of vulnerable populations. Ten alumni have even earned graduate degrees in community nursing and are now serving the community in schools and safety net health clinics.
In addition to benefiting students and community agencies, the 19130 Zip Code Project supports the college’s mission of community engagement—and provides evidence of that support to the citizens of Philadelphia. Through community-based service learning, the nursing program and the college itself embody the values of diversity and engagement that are necessary to building healthy communities and a healthy workforce.