Carmen Amaia Ramírez-Torres1
Elena Andrade-Gómez1*
Cristina Lozano-Ochoa1
María Neus Caparrós-Civera2Esther Sapiña-Beltrán1- 1Predepartment of Nursing, Faculty of Health Sciences, University of La Rioja, Logroño, Spain
- 2Department of Law, Faculty of Social and Legal Sciences, University of La Rioja, Logroño, Spain
Aim: This study aimed to evaluate the theoretical and practical skills acquired by nursing students and school students after the service-learning project.
Methods: This study promotes nursing students and school students working together to gain awareness and basic theoretical knowledge of first aid. The learning project was conducted with nursing students (n = 67) and school students (n = 131) from April to June 2022. The nursing students gave scores higher than 8 on the aspects linked to expectations, self-perception, overall assessment, and attainment of the goals, and these results are in line with the qualitative analysis.
Results: Moreover, 100% of the school students reported a satisfactory outcome about the service.
Conclusion: Service-learning is a challenging and motivating methodology for nursing students, which results in greater engagement with theory and practice and the development of essential skills for future professionals.
1. Introduction
University students must acquire basic theoretical and practical knowledge. However, other competencies are essential such as being able to teach, think critically, empathize, or participate (Al-Omar, 2004; Jones and Kiser, 2014). Service learning comprises learning based on the participatory experience of students framed between democratic theories, pragmatic philosophy, and cognitive and developmental psychology (Long and Gummelt, 2020). It could be defined as more than volunteering; it combines work in the community that situates students in the real world, and they learn new theoretical knowledge while meeting societal needs (Rossenberg, 2000; Chambers and Lavery, 2012; Percy and Richardson, 2018; Oh, 2019).
Martínez Lozano et al. (2018) showed that students who undertake service-learning projects improve in various aspects compared to those who do not undertake service-learning projects. Moreover, some improvements are linked to theoretical aspects such as the overall mean in grades (Prentice and Robinson, 2010), critical thinking (Astin et al., 2000; Prentice and Robinson, 2010), and writing (Astin et al., 2000).
On the other hand, some competencies demonstrate particularly relevant benefits for nursing such as leadership, interpersonal skills (Astin et al., 2000), communication, teamwork, and civic responsibility (Bentley and Ellison, 2005; Prentice and Robinson, 2010).
Nowadays, there is a global concern in nursing about nurse–patient staffing ratios, an issue further highlighted by the COVID-19 pandemic. The deficient nurse–patient ratio entails greater levels of burnout and increases the number of nurses who leave the profession (Galanis et al., 2021). The study by Collard et al. (2020) mentions the importance of suitable training for nursing students to ensure that they are resilient and continue in the profession. However, higher education seems to be failing at introducing students to practice, which is a key point to the completion of nursing training (Baldwin et al., 2014a; Sytsma et al., 2015).
First aid is essential for nursing training too; moreover, it is also important for the general population to have basic knowledge of life support and emergencies (Mohd Sharif et al., 2018). Despite its importance, studies show that first aid knowledge in the general population is lacking (Başer et al., 2007; Joseph et al., 2015; Midani et al., 2019). In Spain, an exploratory study performed in 2018 found that 75.6% of Spanish people consider their knowledge of first aid insufficient [Spanish Society of Emergency Medicine (SEMES), 2018]. However, quick basic first aid can improve patients' future prognosis. Other Spanish studies consider that there is a need to start improving knowledge of basic first aid from schools in our context (Ballesteros-Peña et al., 2016; Rodríguez-Lorenzo et al., 2020).
Service learning allows students to be placed in society and promotes their acquisition of skills that enhance their professional development (Thomas and Smith, 2017). This methodology supports important benefits; this is the reason why the implementation of service learning at the university is a considerable option, particularly for a bachelor's degree in nursing because it can improve the understanding of students about first aid and provide motivation in training. In addition, it could be a service to the community that can improve the knowledge of first aid and the responsibility that people must take in an emergency. The study aimed to evaluate the theoretical and practical skills acquired by nursing students and school students after the service-learning project.
2. Methods
2.1. The “accessible first aid” project
The project was titled “accessible first aid.” A total of 68 nursing students in their third academic year participated in the project. These nursing students did a workshop from April to June 2022 (3 h per week) for 11 groups of students aged 14–18 years from two different schools. The project was divided into 9 weeks (Figure 1).
Figure 1. Accessible first aid project. CPR, cardiopulmonary resuscitation.
The project aimed to promote nursing students and school students working together to gain awareness and basic practical and theoretical knowledge of first aid.
2.2. Design
A post-intervention study was conducted to evaluate the theoretical and practical skills acquired by nursing students and school students after the service-learning project.
The study was approved by the Ethics Committee (CE252022). All nursing students signed informed consent to participate as well as confidentiality agreements with the assurance that they would be used for teaching purposes only and would be kept confidential.
2.3. Study context
The project was performed in a sample of the third academic year students of bachelor's degree in nursing at the University of La Rioja (Spain) in the 2021–2022 academic year. To hold the workshops simultaneously at the schools, the nursing students were split into 11 groups, one group with seven students and 10 groups with six students (n = 67; Figure 2).
Figure 2. Participants flow diagram.
Additionally, a sample of school students received the accessible first aid workshop (n = 131 school students). Two schools were selected by convenience.
2.4. Data collection and instruments
First, a survey was conducted with the students to assess different items in the service-learning project. The survey consisted of 17 items that formed part of an ad hoc questionnaire designed by Gragera et al. (2019), and each item was scored on a Likert-type scale (1–10). The 17 items were grouped into five categories, namely, expectations, self-perception, self-perception with others, overall assessment, and service-learning goals (Table 1).
Table 1. Service-learning activity final assessment rubric.
Second, the nursing students' reflection diaries were collected and anonymized by naming them with the initials of the nursing student and a randomly assigned number. Students were encouraged to record the attitudes and skills they believed they had acquired after participating in the project (Cabillas et al., 2018).
Third, a satisfaction survey was conducted on the school students that contained five dichotomous questions (yes/no), one rating scale (1–10), and the opportunity to provide suggestions.
2.5. Data analysis
Quantitative analysis was performed using Statistical Package for the Social Sciences (SPSS) version 26. Descriptive analysis was conducted on the data to view the results in frequencies, means, and standard deviation.
Qualitative analysis was performed by two researchers using NVivo 2020. They each independently analyzed the texts by setting categories. In the final report, they achieved consensus to establish relationships with the quantitative analysis.
3. Results
3.1. Quantitative analysis
3.1.1. Nursing students
A total of 51 nursing students (76.12%) answered a survey assessing the activity. Of the students surveyed, 80.4% were women aged 20–51, with a mean age of 22 years [standard deviation (SD) 5.36]. None of the participants had previous experience with service learning.
The results of the final survey show a satisfactory rating in the categories of self-perception, self-perception with others, overall assessment, and service-learning goals, as the means in the Likert scale in these categories are higher than 8 (Table 2). In the case of the expectations category, high mean scores in the Likert scale were recorded in all items except the “I have been prejudiced against the people I have worked with” item, which yielded a lower score, with a mean score in the Likert scale of 3.10 (SD 0.38; Table 2).
Table 2. Mean scores on Likert scales from 1 to 10 in the final assessment of the service-learning activity.
3.1.2. School students
In the study, 100% of the school students (n = 131) answered the student satisfaction survey on the first aid workshop. All the students responded positively to the first three questions: (1) “Was the group suitably prepared for the workshop?” (2) “Did the group show interest in helping the students learn?” and (3) “Was the workshop structured in such a way that it helped you learn all the concepts?”. In question four, which covered the importance of what had been learned in the workshop, two students answered that they did not think it was important. However, only one would not recommend this course to other students. The activity received a mean rating of 9.60 (SD 0.73).
3.2. Qualitative analysis
In the study, 94.02% of the nursing students' reflection diaries (n = 63) were analyzed. A summary of the most important perceptions was included (Table 3).
Table 3. Perception of nursing students about service-learning projects.
3.2.1. Perceptions on the service-learning methodology
3.2.1.1. Positive experience
Participants described the methodology as innovative, satisfactory, motivating, interesting, appealing, useful, and effective. It was also categorized as enriching on a personal level. Some participants had a positive perception from the beginning, while others changed their opinion. Finally, they all expressed a positive experience.
3.2.1.2. Suggestions
Some students noted that they would like to do more projects of this nature in other areas of society on other topics, and they remarked on the necessity of using more resources. Others, however, deemed that these types of projects should be carried out at times when there is less study load.
3.2.2. Perceptions on service-learning goals
3.2.2.1. Theoretical knowledge
First, they believe that training in areas linked to first aid has been essential and that this has allowed them to strengthen their knowledge.
3.2.2.2. Teamwork
Teamwork is highlighted, but mention is also made of the importance of these groups being formed by the students themselves on the basis of rapport.
3.2.2.3. Presentation skills
They very positively appreciated the opportunity to present to strangers of different ages. Having a first contact with the teaching role of nursing.
3.2.2.4. Empathy
The need to adapt their knowledge to those of younger school students fosters the development of empathy.
3.2.3. Perceptions on community service
3.2.3.1. Need: teach the community first aid
They thought it was necessary to raise awareness about basic first aid in society. Many of them thought this was a relevant issue and would have liked to have prior knowledge of it before studying nursing; others highlighted its importance due to the positive impact this knowledge may have on survival. Indeed, during the activity, some mentioned a lack of knowledge.
3.2.3.2. Community outreach: a success
Most mentioned that they were satisfied with the activity and the reception they were given by the school students.
4. Discussion
First aid saves lives and must be learned and remembered by everyone in the community (Abelairas-Gómez et al., 2020). This study enabled nursing students to put into practice their knowledge of a real problem that must be addressed in our society [Spanish Society of Emergency Medicine (SEMES), 2018]. Furthermore, introducing school students to first aid in this study allowed for analysis of the perception of the activity from the perspective of nursing students and school students.
The importance of training programs that include service learning as part of the training of future nurses is further underlined (Marcilla-Toribio et al., 2022; Yoong et al., 2022; Zhu et al., 2022). Similar to other studies, the results are highly satisfactory for the students, exceeding expectations and allowing them to develop essential skills for professional competence (Papastavrou et al., 2016; Thomson et al., 2017; Rodriguez and Lapiz-Bluhm, 2018; Lin, 2021), such as leadership and conflict resolution (Saylor et al., 2018; Spencer, 2021).
Students highlighted that they were motivated by the work involved in a different learning environment for students and teachers (Papastavrou et al., 2016; Herrmann, 2020; Godoy-Pozo et al., 2021). In fact, it demonstrates that innovative methodologies boost motivation and encourage self-learning in students (Al Murshidi, 2020). Some of the knowledge they acquired in this project is essential for their professional future, such as empathy, critical thinking, and teamwork (Baldwin et al., 2014b; Thomson et al., 2017). Bringing future nurses and the community together creates the opportunity for conversation with the public and to understand real needs and how to address them. This development of cultural empathy and community nursing offers significant benefits to the nursing curriculum, as has been shown by other published studies (Thomas and Smith, 2017; Rodríguez-Costa et al., 2020; Tanna et al., 2020; Gradellini et al., 2021).
Beaman et al. (2018) found that most studies measured results in nursing students but not in the community itself; in this study, we considered the satisfaction of the school students. In fact, there is a mutual benefit, which should not be overlooked (Cannon et al., 2020; Tyndall et al., 2020). For future studies, measuring the results of service-learning projects in the community is complex and pertinent. Furthermore, in university settings, it may represent an opportunity for interprofessional collaboration (Higbea et al., 2020) with different university courses and degrees, as well as with other universities, to enhance the cross-curricular scope of the content that is offered to school students. Longitudinal studies would also be interesting in assessing the effects of service learning at scales that measure essential skills over the long term.
4.1. Limitations
The study has some limitations that should be mentioned. First, in the study, only students with a bachelor's degree in nursing were included, with a high percentage of women, and this aspect limits the generalizability of our results.
Second, there is no control group using a different methodology than service learning to teach the general population first aid knowledge. Furthermore, no assessment was made of the school students' knowledge before and after the activity, an aspect that may prove interesting.
4.2. Recommendations
This study's methodology has employed tools previously described and used in similar samples. Nevertheless, there are, at present, very few studies that use the service-learning methodology in an activity led by nursing students for school students. The majority of the studies included activities with older populations (Gardner and Emory, 2018; Kwok et al., 2021) and vulnerable adults.
5. Conclusion
University teaching occasionally features a gap between theory and practice. The positive results of this study on nursing students' first aid motivation and training encourage the development of health professional training programs that include service learning as an ideal methodology. For that reason, nursing teachers must take responsibility within their capacity for the advancement and progression of future nurses by making them aware of the circumstances in their communities.
Data availability statement
The data that support the findings of this study are available from the corresponding author, upon reasonable request.
Ethics statement
Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.
Author contributions
CR-T: Conceptualization, Investigation, Methodology, Writing—original draft, Writing—review & editing. EA-G: Formal analysis, Investigation, Writing—original draft, Writing—review & editing. CL-O: Conceptualization, Writing—review & editing. MC-C: Methodology, Writing—review & editing. ES-B: Funding acquisition, Investigation, Supervision, Writing—original draft, Writing—review & editing.
Funding
The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by University of La Rioja.
Acknowledgments
IES Práxedes Mateo Sagasta and Colegio Purísima Concepción.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: health education, community integration, nurse, education, social learning, students, nursing, first aid
Citation: Ramírez-Torres CA, Andrade-Gómez E, Lozano-Ochoa C, Caparrós-Civera MN and Sapiña-Beltrán E (2023) Nursing students bringing first aid to the community. Front. Educ. 8:1288508. doi: 10.3389/feduc.2023.1288508
Received: 04 September 2023; Accepted: 13 October 2023;
Published: 09 November 2023.
Edited by:
Raquel Leirós-Rodríguez, University of León, SpainReviewed by:
Aneta Grochowska, University of Applied Sciences in Tarnów, PolandJulie Alexander-Ruff, Montana State University, United States
Copyright © 2023 Ramírez-Torres, Andrade-Gómez, Lozano-Ochoa, Caparrós-Civera and Sapiña-Beltrán. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Elena Andrade-Gómez, elena.andrade@unirioja.es