Abstract
The authors examined factors influencing nursing student involvement in optional service learning activities in one nursing program. Participation was related to a student’s age, employment status, and year in school. These factors may be applicable to other nursing programs despite differences in service learning projects and student populations. Opportunities for promoting involvement in service learning are discussed.
Introduction
Nursing today needs individuals who have positive approaches to life and who value caring about and caring for others. Service learning is one pedagogical method faculty members use to assist students in developing values they need as they enter professional nursing practice, including caring and empathy, which will assist in the delivery of quality patient care.
Since 2009, we, as the primary faculty in one nursing program, have offered students the opportunity to participate in optional service learning experiences with community and nonprofit organizations. During the first week of classes each semester, each of us provided students in our respective classes with information outlining the benefits, expectations, and responsibilities associated with participating in the voluntary service learning experiences. Service learning was introduced as an opportunity to increase self-awareness of professional responsibilities and help students become more empathetic. The time commitment, available times, specific activities, and the self-reflection process were reviewed in class, and detailed information was provided online in the course management system. Students would then use the course management system to review and sign up for service learning activities and submit their self-reflection. Each of us maintained frequent email and phone contact with the participating community partners, making periodic visits to the agencies and occasionally participating in service learning activities with the students.
To try to appeal to more students and increase levels of participation, we have designed a variety of service learning experiences that support specific learning objectives in each nursing course, adding experiences as opportunities arose. First-year nursing students serve meals at a local senior activity center, reflecting on the differences in interactions among older adults in the community versus those in long-term care. They also assist long-term care residents on community outings, discussing the obstacles faced when navigating public venues with a handicapped individual. Second-year students provide office help, take vital signs, and measure weights at a clinic whose mission is to provide health care for persons who are employed yet are without health insurance. They also administer flu vaccinations to residents in long-term care facilities and, as part of their pediatric rotation, perform age-related screenings for hearing, vision, and scoliosis at local elementary schools.
The level of faculty engagement varied. With all student activities, faculty members were involved either through arranging the activities and/or personal participation in the activities. With the first-year activities, faculty members were usually not present on site and students were under the direction of the staff at the respective facilities. For the second-year activities, a faculty member or a nurse preceptor presence was required at most activities because of the performance of direct patient care skills such as administering injections. When faculty members were present, they engaged students in immediate self-reflection regarding their experiences; otherwise, instructors spoke with the students participating each week in class regarding their experience.
Initially, students did not receive any additional course credit for participation. In the past two years, we began supporting each service learning project by extending either credit towards open laboratory hours or course credit in lieu of a writing-intensive assignment. To receive service learning credit, students had to complete a self-reflection exploring the impact of the activity on their professional development. Permitted self-reflection activities included poetry, art, journaling, and song. We estimated the time commitment required for each activity, and in an attempt to increase participation, awarded service learning credit on the premise that the service learning time commitment was smaller compared to completing the alternative activities. The university recognized those participating in service learning by hosting a luncheon each semester, awarding participation certificates, and honoring outstanding volunteers.
To better understand students’ motivations for involvement in service learning, we decided to explore the ways in which participants distinguished themselves from non-participants. What factors were influencing students’ participation in service learning? Did those who had higher self-rated levels of empathy and caring elect to participate? The purpose of this study, therefore, was to investigate factors that influence participation in service learning. Applying a new understanding of these factors influencing participation could then guide faculty in developing practices to support service learning participation with the potential to improve the quality of nursing student education.
Despite the increase in the service learning options and the extension of course credit, we have noted that while there has been an increase in participation over the past two years, only half of the students opt to participate in service learning. While this is a higher percentage than the 31% participation rate in institutions like ours where service learning is only an optional experience, we recognize the benefits of service learning and realize that students can only obtain these benefits if they participate (Service Statistics, 2008). To date, there are no studies specifically evaluating factors influencing nursing student participation in service learning. Recent studies of college students’ service learning suggest that students choosing to participate in service learning are different from other students. Women are typically more likely to participate in service (Chesbrough, 2011). Increased engagement in service learning has been noted in students with prior or current volunteer experience with one or more organizations (Basco et al., 2005), as well as students who consider themselves more religious-oriented (Beckman & Tozzolo, 2002). Students have described choosing service learning with the hope that it would offer them more flexibility regarding when they needed to complete course assignments (Karasik, 2005). Students who are employed are less likely to participate in service learning options, citing time constraints or being too busy as the main reasons for not participating in service learning (Ender, Martin, Cotter, Kowalewski, & Defiore, 2000).
In the current economic times, there has been discussion of the reasons students choose to enter nursing. While the dominant factor is the desire to care for and help others, some cite reasons that are not as altruistic and more related to economics, including job security and flexible hours (Newton, Cherene, Kremser, Jolly, & Billett, 2009). Watson’s theory of human caring relates that caring is grounded in humanistic altruistic values, including empathy, concern, and love for others (Watson, 2007). In applying this tenet to service learning experiences, we thought that the students choosing nursing for altruistic reasons would have higher caring and empathy levels and that these were the students choosing to participate in the optional service learning activities.
Methods
This study utilized a quasi-experimental design comparing students’ demographic variables and scores on empathy and caring scales based upon level of service learning participation. The sample consisted of 97 students enrolled in one associate degree nursing program in Northeast Ohio. After obtaining IRB approval, faculty distributed a packet of self-report surveys to all students at the end of the academic year during course evaluation activities. Completion of study instruments was voluntary and replies confidential.
Students completed a purposefully designed demographic tool assessing participation in service learning and variables of interest identified in the literature that may affect service learning participation, including previous and current levels of community volunteer work, employment status, and religiosity. To evaluate the presence of professional nursing behaviors associated with service learning participation, students completed the Jefferson Scale of Empathy for Nursing Students (JSEN) and the Caring Dimensions Inventory (CDI). The JSEN is a self-report scale with 20 items on a 7-point Likert-type scale ranging from one, strongly disagrees, to seven, strongly agree. Higher JSEN scores indicate more empathy, defined as the ability to perceive the feelings and enter into the life of another (Ward et al., 2009). The CDI is a self-report scale with 25 items on a 5-point Likert-type scale ranging from one, strongly disagree, to five, strongly agree. Higher CDI scores indicate higher levels of caring, representing psychosocial, professional and technical aspects of nursing (R. Watson & Lea, 1997). Both tools have established reliability and validity with nursing students (Chesbrough, 2011; J. Watson, 2007).
Demographic factors and variables of interest were evaluated using Chi-square tests of association. Means comparison tests (ANOVA and t-tests) were performed to assess for differences in caring and empathetic qualities between students’ who did and did not participate in SL. Data analysis was performed using SPSS 17.0. Level of significance was established at p=.05.
Results
The data in Table 1 present a profile of the sample by their answers to the demographic questions. The sample was nearly divided between those who participated in service learning (52.6%) and those who did not (47.4%). More women responded than men did, which is representative of the pattern of this nursing student population. The majority had prior volunteer experience with 35% reporting current participation in volunteer activities outside of service learning.
Several factors correlated with student participation in service learning (Table 2). Students who participated in service learning were more likely to be in the second year of the nursing program and not employed full- or part-time. Age had a significant impact on participation, with those students who were over age 25 more likely to participate than their younger peers. In this cohort, gender, a history of previous volunteer work, participating in current volunteer experiences outside of service learning, and religiosity did not have a relationship with service learning participation.
Table 1 Demographic Characteristics
| Characteristic | N (97) | Percent |
| Service Learning Option | ||
| Participated | 51 | 52.6 |
| Did not participate | 46 | 47.4 |
| Gender | ||
| Female | 79 | 81.4 |
| Male | 18 | 18.6 |
| Class Standing | ||
| First-year | 67 | 69.0 |
| Second-year | 30 | 31.0 |
| Age | ||
| 19- 25 | 48 | 48.5 |
| 26- 32 | 20 | 20.2 |
| 33- 39 | 17 | 17.2 |
| 40 and over | 12 | 12.1 |
| Employment | ||
| Full-time | 11 | 11.1 |
| Part-time | 55 | 55.6 |
| Not employed or looking for work | 14 | 14.1 |
| Not employed and looking for work | 16 | 16.2 |
| Prefer not to answer | 1 | 1.1 |
| Previous Volunteerism | ||
| Yes | 67 | 69.0 |
| No | 30 | 31.0 |
| Current Volunteerism | ||
| Yes | 34 | 35.0 |
| No | 63 | 65.0 |
| Religious Service Attendance | ||
| Yes | 38 | 39.2 |
| No | 57 | 58.8 |
| No Answer | 2 | 2.0 |
Table 2 Factors Influencing Service Learning Participation
| Characteristic | Participated | Did not Participate | Chi-Square | ||
| N (51) | Percent | N (46) | Percent | ||
| Gender | 0.586 | ||||
| Female | 43 | 44.3 | 36 | 37.1 | |
| Male | 8 | 8.3 | 10 | 10.3 | |
| Class Standing | 10.108** | ||||
| First-year | 28 | 28.9 | 39 | 40.2 | |
| Second-year | 23 | 23.7 | 7 | 7.2 | |
| Age | 10.83 ** | ||||
| 19- 25 | 18 | 18.6 | 30 | 31.0 | |
| 26- 32 | 15 | 15.5 | 5 | 5.2 | |
| 33- 39 | 9 | 9.2 | 8 | 8.2 | |
| 40 and over | 9 | 9.2 | 3 | 3.1 | |
| Employment | 11.234 ** | ||||
| Full-time | 7 | 7.2 | 4 | 4.1 | |
| Part-time | 21 | 21.7 | 34 | 35.1 | |
| Not employed or looking for work | 10 | 10.3 | 4 | 4.1 | |
| Not employed and looking for work | 12 | 12.4 | 4 | 4.1 | |
| Prefer not to answer | 1 | 1.0 | 0 | 0 | |
| Previous Volunteerism | 0.010 | ||||
| Yes | 35 | 36.1 | 32 | 33.0 | |
| No | 16 | 16.5 | 14 | 14.4 | |
| Current Volunteerism | 1.772 | ||||
| Yes | 21 | 21.6 | 13 | 13.4 | |
| No | 30 | 31.0 | 33 | 34.0 | |
| Religious Service Attendance | 2.237 | ||||
| Yes | 21 | 21.7 | 17 | 17.5 | |
| No | 30 | 31.0 | 27 | 27.8 | |
| No Answer | 0 | 0 | 2 | 2.0 | |
There were no differences or relationships between caring and any study variable. Some significant relationships existed regarding empathetic qualities (Table 3). The first-year students who participated in service learning were significantly more empathetic than their fellow first-year students who did not participate in service learning; this difference in empathy, however, did not exist among second-year students. Overall, first-year students were more empathetic, with an average score of 115.1, compared to an average score of 109.2 for second-year students. The second year students who participated in service learning in their first year of study had slightly higher average scores on the JSEN; however, this difference was not significant.
Table 3 Students’ Empathy and Caring Qualities
| Characteristic | Empathy | Caring | ||
| Mean Score | Test | MeanScore | Test | |
| Service Learning All Students | ||||
| Participated | 115.68 | t=1.07 | 103.8 | t= -0.050 |
| Did not participate | 110.31 | 103.7 | ||
| Class Standing | ||||
| First-year | 115.1 | t= -1.696* | 103.6 | t=.203 |
| Second-year | 109.9 | 104.1 | ||
| First Year Student Participation | ||||
| Yes | 119.3 | t= -2.349* | 103.2 | t=.812 |
| No | 111.5 | 107 | ||
| Second Year Student Participation | ||||
| Yes | 110.0 | t=-0.021 | 104.3 | t=-0.445 |
| No | 109.9 | 103.1 | ||
Discussion
To our knowledge, this is the first study evaluating factors influencing nursing students’ voluntary participation in service learning activities. A student’s age, employment status, and year in nursing school appear to have a relationship with a student’s choosing to participate in service learning; those who are older, not employed, and in the second year of school are most likely to participate. Contrary to prior studies, gender or current or prior volunteer experience did not distinguish service learning participants. Religion did not appear to exert a greater influence in the lives of those who participated in service learning as service learning students were not more likely to report participating weekly in religion-related activities.
It does appear that being employed is one of the primary factors influencing service learning participation. These results are consistent with findings regarding the impact of employment status on service learning participation. It is possible that employed students elect not to participate in service learning as they do not see the required time commitment as feasible given their work schedule or they perceived they were too busy to be able to participate in service learning with work and school activities. To increase participation in service learning among students who may perceive time barriers, we recommend offering service learning experiences close to students’ homes and workplaces. Offering a choice among different types of service learning projects and the use of one-time projects or special service days, including increasing evening and weekend opportunities, may make service learning a more appealing option to those students perceiving time constraints.
Communication may play a role in overcoming perceived time constraints. Students in all service learning courses were required to either complete the service learning option or participate in other course assignments, such as writing a research paper or additional open laboratory hours. We estimated the time commitment required for each activity, awarding equal credit for each activity on the premise that the required time commitments were equivalent. It may be that faculty utilizing service learning need to convey more strongly to students that service learning is not a more time-intensive option among the course requirement choices and in fact, is intended to be a less time-intensive option.
We believed nursing students who elected to participate in service learning would have higher self-rated levels of empathy and caring and a significant difference in empathy did exist between those who chose to participate in service learning, but only among first-year students. By the second year, however, the difference in empathy dissipated and, more alarmingly, coincided with a significant decline in level of empathy from the first to the second year. However, the cohort of second-year students who participated in service learning during the first year did have a slightly higher JSEN score than their peers, which is consistent with reports that students who consistently engage in service learning demonstrate higher levels of empathy (Groh & Stallwood, 2011; Lundy, 2007; Wilson, 2011). Based on these findings, we feel that empathy is an untrustworthy driver and that the motivation for service learning participation, after removing time constraints, is that students who participate are likely do so because they feel they directly benefit in some manner. The motivating factors likely vary and are probably similar to reasons students participate in volunteerism in general; students may want to expand their learning, gain valuable work skills, participate in a new experience, or enhance their personal development.
We find the overall decrease in empathy between first and second year students disturbing.We expected that empathy levels would increase as the student interacted with patients and caregivers in the course of their service learning and clinical experiences. While there was some indication that service learning may influence this decline, the reasons for the decline are unclear. One possible reason is that the idealism with which the student enters school is diminished as the student confronts the realities of clinical experience and exposure to illness, suffering and death. Another possibility is that as students enter their second year of study, the stress associated with the demands of long hours of study with increased course difficulty, more assigned clinical hours, and increased coursework assignments contributes to a decline in empathy.
So why was there an increase in the likelihood of participating in service learning in second-year students? Most of these students had done so during their first year of study and, ideally, finding the experience valuable, chose to participate when again offered the option. It is plausible that they did so because service learning offered an experience outside of what they had normally encountered in the classroom or they have a personal commitment to helping others; the service learning activities allowed them an opportunity to provide assistance to the underserved in the community. This cohort had a smaller decline in empathy levels, which may support the premise that service learning has an impact on students’ empathy. If this is true, then faculty members teaching lower division courses play a critical role in student development by utilizing service learning activities that not only relate to course objectives but also are designed to increase students’ initial participation in service learning.
While we were surprised that religiosity did not play a role in service learning participation, this is actually affirming that participation may be more rooted in altruistic motives. Given the emphasis that religion places on service to others, particularly to underserved populations, we anticipated that the service learning activities, such as working with the uninsured and older adults, would appeal to this sense of obligation to others. However, if religiosity does not influence service learning participation, then it is more likely that voluntary participation relates back to basic human nature with serving others, giving back, and making a difference being motivators of the religious and non-religious alike.
Along with promoting service learning involvement, we need to address how to prevent the decrease in empathy and develop empathetic skills in students. An intervention study needs to be performed to test the outcomes of service learning and similar pedagogies to identify if service learning has any direct influence on developing empathy and caring traits. Research is also needed to determine which service learning activities are associated with promoting empathy so that faculty can design activities that intentionally promote the development of students’ empathetic qualities.
A few limitations affect the conclusions drawn from study findings and limit generalizability. First, this study is limited by the convenience sample of nursing students enrolled at one university. While a majority of first-year students returned the surveys (67 of 73), only 30 of the 54 second-year students returned the surveys so there may be some selection bias between those who chose not to participate and those who did. Factors not evaluated here may influence service learning participation, including perceived level of family obligations, personality characteristics, or the appeal associated with the types of service learning activities offered. Finally, the use of a cross-sectional design makes it difficult to ascertain whether the higher level of empathy was present because the student participated in service learning or if the students who chose to participate in service learning had higher levels of empathy prior to participating.
Conclusion
To assist students in developing empathy and professional values, service learning has been integrated into the curricula of first- and second-year nursing students. Having a better understanding of factors influencing students’ participation in service learning will allow faculty to employ interventions to minimize any obstacles to students’ participation. An initial step is to develop a wide range of service learning activities in order to appeal to students with various needs. This will assist faculty in facilitating effective service learning experiences and fostering an environment of service.
References
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About the authors:
Mariann Harding
Mariann Harding, PhD RN CNE, is the Service-Learning Coordinator for Kent State University Tuscarawas, a regional college in the Kent State system. Her charge as coordinator is to support and guide service learning projects for the campus. She is responsible for creating relationships for community partners and faculty members that benefit and enhance real world life experiences for students, while satisfying a community need. In addition, she has been a service learning practitioner for 6 years. Associate Professor, College of Nursing, Kent State University Tuscarawas, 330 University Dr., New Philadelphia, OH 44663. [email protected]
Denise McEnroe-Petitte
Denise McEnroe-Petitte, MSN RN, is a nursing faculty member at Kent State University Tuscarawas and a 7-year service learning practitioner. She was this past years’ recipient of the “Outstanding Service-Learning Faculty Practitioner” award. © 2014 Journal for Civic Commitment