Running head: SUMMATIVE SERVICE-LEARNING REFLECTION

Summative Service Learning Reflection

NUR 4144: Professional Role Development Servant Leadership

Kelsey Singh

October 9, 2018

“I have neither given nor received aid, other than acknowledged, on this assignment or test, nor
have I seen anyone else do so.”
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The purpose of this paper is to capture my reflection on how service-learning

experiences during my nursing training have shaped my values as a nurse. Out of high school, I

choose nursing education for two main reasons—the job market is strong for nurses and since I

am not squeamish, I thought nursing would provide interesting, stimulating experiences. In my

second year at Old Dominion University, I faced the difficult choice of staying at ODU, which I

loved, or finding another nursing program to continue my pursuit of a BSN. As I considered my

dilemma, the best answer for me became surprisingly clear. Bon Secours Memorial College of

Nursing and I chose each other, and my journey on a service and community-based path to

nursing began.

Noticing and Interpreting

Initially, I continued to focus on career development, but my expectations expanded to

include focused treatment of patients’ illness. As I studied theories of nursing and more

importantly worked with real patients, I quickly learned that my treatment expectation was too

narrow. A nurse’s impactful treatment of a patient’s physical health must include

acknowledgement of the role mental health, family, and community play in a patient’s illness

and healing. Service learning became defined for me as engaging with the patient’s total

community to define the patient’s health care imperatives that shape the patient’s health care

needs.

I have learned the community in Richmond has both weaknesses and strengths. The

overarching weakness is that too many patients lack adequate access to health care. Several

factors impact access to health care. Many patients cannot afford even basic health care,

especially for chronic illness. In addition, too many patients lack sufficient health care
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education or awareness to know to seek treatment or to understand the consequences of

waiting too long for treatment. Thus, these patients present with advanced illness that is more

expensive to treat, for the patient and the health care provider. From the nurse’s perspective,

adequate access is further hindered by a lack of nursing resources to address growing

community needs caused by many reasons. These reasons include increase in chronic illnesses

such as diabetes and heart-disease, and extended life-expectancies. Other reasons include

advanced medical interventions that improve patient outcomes but require dedicated nursing

resources, such as specialized intensive care units that may have a one to one ratio of nurse to

patient, and the globalization of healthcare. This lack of nursing resources is compounded by

an increased focus and access in the nursing community to become something other than a

bedside nurse; thus, nurses are becoming Nurse Practitioners, Certified Registered Nurse

Anesthetists, “Nurses Without Borders” in developing countries, and Nursing Instructors, to

name a few other positions.

In this same Richmond community, however, I see many strengths that provide

solutions to the community’s healthcare problems. In Richmond, access to nursing programs

has expanded. For example, Bon Secours recently increased its nursing program class size from

50 to 100 students. Richmond has numerous hospitals, both private and public, and they offer

robust indigent care programs that provide free or reduced fee access to acute and managed

medical care. As a state teaching hospital, VCU Health’s Virginia Coordinated Care program

provides primary and follow-up care on a free or reduced basis to qualified patients, and VCU

nurses serve in many capacities, such as as bedside nurses, case managers, and outreach

facilitators. To attract more nurses and other medical professionals, hospitals are becoming
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more flexible and creative with employee-friendly options, such as on-site 24-hour childcare

facilities, extended shifts, and tuition reimbursement programs. In addition, Nurse

Practitioners are increasingly able to work independently of doctors; while this does not help

the shortage of bedside nurses, it does facilitate increased access to affordable healthcare.

However, the greatest strength I have observed in this community is the selfless servant

attitudes that nurses and nursing students exhibit. I see nurses watching patients, not clocks;

taking time to hug and reassure family members; providing little kindnesses that do not involve

medical care, but have everything to do with healing, like brushing a patient’s hair or massaging

a patient’s back while listening to the patient’s stories.

I am a “person of color” with a Black and East Indian heritage, who grew up in a middle-

class home with a loving extended family and full access to healthcare of all types. I believed

income often determined quality of healthcare, but I did not give much thought to access issues

until I started the nursing program at Bon Secours in 2016, about the same time Congress

began dismantling the Affordable Care Act. Through media coverage, family debates, and

classroom discussions, I realized that access issues spread across patient communities, without

regard to race, religion, citizenship, and sometimes, socioeconomic status, such as when a pre-

existing condition could cause un-insurability. I realize now how blessed and protected my life

has been, but my nursing program opened my eyes to the variety of healthcare issues that

require service oriented medical professionals to provide solutions.

Responding

First and foremost, I have learned that there is not a fix for every need in the

community. Also, patient engagement is requisite for a successful outcome, however that must
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be defined. During my nursing program, I have participated in several service learning

experiences. I have volunteered with Special Olympics of Virginia, conduced elementary school

medical screenings, and helped to organize a team from the VCU Health Cardiac Surgery ICU

(and to design the team T-shirt) for the annual Richmond HeartWalk. These service learning

activities have differing levels of relevancy to my learning experiences and to the community.

The HeartWalk is a fundraiser, so I am helping to address big-picture issues like community

education and research. Conversely, medical screenings require hands-on contact with

community members, which has an immediate impact on the individual patient and allows me

to see how other factors influence the effectiveness of community engagement. Special

Olympics combines the best of big picture impact with one on one engagement with a

community member.

Reflecting on Service Learning

My service learning experiences put a face on the community, turning it from a

classroom concept to people. These experiences have also enlightened me to the necessity and

difficulty of funding, because without it, even selfless servants cannot provide basic healthcare.

I now realize that nursing really is a call to serve the patient and the relevant communities that

effect that patient. I also realize that I need additional understanding of policy determinations

that influence community outcomes.

My service learning activities took me beyond the bedside into the community to

broaden my understanding of the many imperatives that impact my ability to help a patient

heal. They have also helped me redefine what a successful outcome is, based on an assessment

with the individual patient, his community, and other medical professionals. For me, service
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learning now encompasses an understanding that community engagement at varying levels

beyond bedside patient care is necessary to develop an understanding of the policy imperatives

that impact quality and availability of healthcare. Such experiences also increase nurses’

awareness that presenting symptoms are always influenced by community factors such as

patient healthcare education, socioeconomic status, and family.

Prior to the service learning activities noted above, my early nursing classes offered

insights into service learning. During Foundations of Nursing Scholarship (NUR 1100), I

volunteered with a Non-Governmental Organization that focuses on affordable housing, where

I was exposed to policy concerns surrounding funding, education, and legislative initiatives. In

Vulnerable Populations and Global Health (NUR 3113), I visited many local care centers, where I

gained a realization that vulnerable populations identified on a global level are equally

prevalent in this immediate community. Mental Health (NUR 3114) required visits to local

mental health centers, where we discussed how appropriate interventions positively change

lives. Finally, my service activity in Metaphysical Nursing (NUR 4144) involved visits to a

children’s home, where I engaged in everyday activities with the children, such as kickball,

drawing, and coloring. During these ordinary engagements, the children would often begin to

discuss there fears, hopes, dreams, all pieces of a successful healthcare plan and outcome.

Each early experience offered a different insight into the breadth of a patient’s community and

the critical importance of continuing service learning activities, even beyond the classroom.

Reflecting on Civic Engagement

A formal definition of civic engagement is “activities intended to positively influence the

civic life of communities and to develop knowledge, skills, values, and motivation (Embree & Lu,
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2016, p. 2). Embree & Lu state that civic engagement includes personal integrity, social

conscience, political engagement, and civic involvement (2016). From my perspective, civic

engagement means I am a participant in many of the communities that include my patients, so

that I continue service learning activities even as I move from student to clinical nurse and

beyond. I just accepted a job offer as a clinical nurse in the VCU Health CSICU. When I

graduate, most of my efforts will be geared toward learning and achieving my job description. I

also plan to join related professional organizations like the American Nurses Association. In

addition, I will complete relevant in-service training when possible. Since VCU Health serves

such a diverse population, however, I will need to continue to build my knowledge of unique

community needs by moving beyond CSICU patient care to engage other healthcare

professionals, family, social workers, case managers, and therapists in developing a

comprehensive plan to define and ensure a successful outcome. Embree & Yu state that

nursing civic engagement has declined similarly to the decline in general civic behavior (2016).

Thus, nurses are less engaged with “communities, government processes, and collaborative

problem solving” (Embree & Yu, 2016, p. 1). I have begun to understand the legislative role in

health care, for patient access and care, and for nurses as advocates for nursing and community

health. I will find ways, therefore, to educate myself on political processes as I continue to

develop my understanding of community needs, to increase my effectiveness as a

nurse/patient/community advocate. Finally, I will seek team-building opportunities with my co-

workers, such as committee membership, because I have observed the value of collaborative

healthcare.
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References

https://www.researchgate.net/publication/305362545_Civic_Engagement_Experiences_of_Stu

dents_Preparing_for_Roles_as_Clinical_Nurse_Specialists_Civic_Engagement

Embree, Jennifer & Lu, Yvonne. (2016). Civic Engagement Experiences of Students Preparing for

Roles as Clinical Nurse Specialists: Civic Engagement. Nursing Forum. 52. 10.1111/nuf.12170.