Empathy and Care Outcomes of Service Learning In Students

A Mixed Methods Study for Nursing

John F. Martin, Ph.D(c)

Empathy and Care Outcomes of Service Learning In Students

• A dissertation study in progress, exploring affective outcomes of service learning in bachelor’s nursing students.

• The study is inter-disciplinary, near the intersection of higher education research, nursing, and moral development.

• Service learning as understood today, developed across the past three decades (Butin, 2010).

Problem and Purpose• Educators who utilize service learning are not often sure why.• To explore changes in affective – rather than cognitive --

personal development pertaining to empathy and caring.• Qualitative research uses a pre-test / post-test design, before /

after students’ first service learning experience in nursing. Data collected from nursing students at variety of campuses.

• Participants recruited from Nurses Christian Fellowship (ncf-jcn.org) and Okla. Nursing Student Assn. (oknsa.org).

• Qualitative data gathered via student interviews.

Problem and Purpose

• Experiential learning (clinical rotations) already a required component (National Council of State Boards of Nursing, 2005).

• Janet Eyler (2002) explicitly applied service learning to nursing.• Often found in community nursing, global nursing, or as activities

in other courses (American Assoc. of Colleges of Nursing, 2008).• The field of nursing education has an emerging, but still largely

uninformed, understanding of the true effect of service learning on nursing students.

Definition of Key Terms

• Experiential learning – is a broad category of experience-based learning, in which the student gains ‘hands-on’ experience in tandem with learning process (John Dewey, 1938; David Kolb, 1984). Service learning is experiential.

• Clinical experiences that are a required part of nursing education is experiential, but many are not service learning.

Definition of Key Terms• Service learning – is a course-based, credit-bearing experience

in which students participate in an organized service activity that addresses a community need, then reflect on the experience in ways that are relevant to the course content and encourage the development of personal values and civic responsibility (Butin, 2005, 2010; Steinberg et al., 2010).

Definition of Key Terms• Community engagement – refers to the ways that a particular

institution of higher education and its students serve the community. • This model of campuses engaging in meaningful ways with its

community is sometimes referred to as engaged scholarship, with service learning as one component of it (Butin, 2010).

Definition of Key Terms

• Empathy – There is a distinct literature in the academic area of empathy research, beyond the scope of this study.

• Davis (1996) described empathy as an ability to understand the emotional perspective of others, to feel compassion “for their sorrow, the resentment when they are slighted, [and] the joy when they triumph” (p. 2).

Definition of Key Terms• Care – A construct that infers “a concerned or troubled state of

mind . . . arising from responsibility” and “attentive assistance or treatment to those in need” (The American Heritage Dictionary of the English Language, 2011).

• Caring is a process, a way of being with another that helps the person develop into their full potential (Mayeroff, 1971).

• Care ethicists -- care in context of relationships.• Nell Noddings (1984/2003) – saw care as face-to-face attempt to

respond to the needs of one who is cared for, using the response of the cared-for to assess and shape what is done to meet the needs.

Theoretical FoundationsNoddings’ Ethic of Care (1984/2003)

• A Care Ethicist, coming from the field of moral development.• Viewed caring as a feminine, nurturing posture. • Not a rules-based ethic.• Instead grounded in the relationship of the ’Carer’ and the ‘Cared-

for’.• All are respected as beings, as context for care.

Theoretical FoundationsNoddings’ Ethic of Care (1984/2003)

• Extensive writings to comprise a working theory (Sanderse, 2012).

• Alignment with Martin Buber’s (1970) I and Thou.

• Crowley (1994) identified Noddings’ theory as a paradigm for understanding nurse/patient relationships.

Theoretical FoundationsNoddings’ Ethic of Care (1984/2003)

• Cooley (2010):

• Saw Noddings’ theory as effective for teaching college students to care about injustice.

• Pressed for more use of Ethic of Care in higher education.

Theoretical FoundationsKatie Erikkson’s Theory of Caritative Care (1988)

• Caritas – the motive that is the substance of care, expressed in ways of alleviating human suffering and preserving health and life (Eriksson, 2002).

• Understanding of humans as soul & spirit, residing in a body that is both holy and spiritual (Eriksson, 2002).

• Caring identifies with suffering, sees dignity as serving with love for the sake of others (Eriksson, 2002).

• Theory unpacked further in Eriksson, Peterson, & Zetterlund’s (2006), The suffering human being.

Emergence of the Notion of Care• Ancient beginnings• Seneca (4 B.C.E.-65 C. E.) • Christ’s Parable of the Good Samaritan (Luke

10:29-37)• European philosophers • Johann Wolfgang von Goethe• Johann Gottfried Herder• Soren Kierkegaard• Martin Heidegger

• Contemporary proponents• Milton Mayeroff• Carol Gilligan• Nell Noddings

Care ethicists

Service Learning in Medical and Health Education

• Service learning – primary location in the literature of higher education research, but also in nursing education, medical education literature.

• Wide variety of disciplines – allied health education, dental, medical, nursing, pharmacology, physical therapy. Most were case studies with limited external validity.

• Calls for additional and comprehensive studies applying service learning in medical and healthcare education (Groh et al., 2011; Lattanzi et al., 2011).

Reality of the present research. . . Assessing affective outcomes

Quantitatively Measuring the Softer Side

Measure of Moral Orientation (MMO-2)

(Liddell, Halpin, & Halpin, 1992)• A snapshot of a student’s moral orientation (as more toward):

Greater care Greater justice

Morality within an ethic Morality in line with justice and ethic of care (Gilligan, 1982) fairness (Kohlberg, 1971)

Seven ethical dilemmas; 52 questions.

Kiersma-Chen Empathy Scale (KCES)(Kiersma, Chen, Yehle, & Plake, 2013)

•Measurement for levels of empathy in nursing and pharmacology students.

Strongly Disagree / Disagree / Somewhat Disagree / Neutral / Somewhat Agree / Agree / Strongly Agree

Research QuestionsQ1. When compared to no service learning, does service learning result in significantly different changes in empathy, as measured by the KCES, from Time 1 (before service learning) to Time 2 (after service learning)?

Q2. When compared to no service learning, does service learning result in significantly different changes in moral orientation toward care, as measured by the MMO-2, from Time 1 (before service learning) to Time 2 (after service learning)?

Q3. What meaning do nursing students attach to the service learning experience with regard to viewing themselves as empathetic caregivers?

H1a. Within students there are significantly different changes in empathy, as measured by the KCES, from Time 1 (before service learning) to Time 2 (after service learning), as compared to no service learning.

H2a. There are significantly different changes in moral orientation toward care in students, as measured by the MMO-2, from Time 1 (before service learning) to Time 2 (after service learning), as compared with no service learning.

(Students will score higher in empathy and moral orientation toward care after service learning).

Hypotheses

Methodology Mixed methods quasi-experimental design, in a

sequential explanatory style (Cozby & Bates, 2012; Teddlie & Tashakkori, 2009)

Quantitative research, pre-test /post-test (service learning as independent variable)

Empathy and care are dependent variables Power Analysis to determine number for significance Comparison group for added validity (not a control

group, as in true experimental design)

Methodology Statistical analysis via F tests and a statistical test of MANOVA

The Kruskal-Wallis, or similar non-parametric method for testing the sample, will be utilized as needed if the samples do not originate from a normal distribution (Mayers, 2013).

Qualitative: Individual interviews with 11-16 students who self-identify as interested in providing more detailed response.

Qualitative descriptions will be manually coded in several categories.

Assumptions & Limitations Service learning – does not allow for a separation of self-

report data (Bob Bringle, personal communication, May 13, 2015).

By design, the study gathers data from students at multiple institutions. Cannot control for a variance in the service learning quality of experience across institutions.

Previous service learning in non-nursing courses, previous healthcare employment are potentially complicating variables.

Significance of the Study Located at the intersection of:

Higher education research in service learning Nursing education research Moral development

Increase an understanding of the potential of service learning experiences and outcomes

Empathy and Care Outcomes of Service Learning In Students:

A Mixed Methods Study for Nursing

John F. Martin, Ph.D(c)Oklahoma City, OK

www.forsterconsulting.bizForsterConsult@cox.net