This presentation of a doctoral study was prepared for the Conference on Medicine and Religion, 2017.

1. Empathy and Care Outcomes of
Service Learning In BSN Students
A Mixed Methods Study for Nursing
John F. Martin, Ph.D(c)

2. Empathy and Care Outcomes of
Service Learning In Students
• A dissertation study exploring affective outcomes of service
learning in bachelor’s nursing (BSN) students.
• Conducted as higher education research, with relevancy to
nursing education and moral development.
• Service learning as understood today, developed across the
past three decades (Butin, 2010).

3. Medical and Health Education
Literature on Service Learning
• SL literature originally emerged from higher education research
• Eyler (2002) applied it specifically to nursing
• Also found in the literature of other of medical / health
disciplines:
• Medical, pharmacology, physical therapy, dental, allied health.
• Most peer-reviewed were case studies; limited external validity.
• More recent calls for comprehensive studies applying service
learning in medical and healthcare education (Groh et al., 2011;
Lattanzi et al., 2011).

4. 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

5. Problem and Purpose
• Experiential learning via clinical rotations now officially
required (Ntl. Council of State Boards of Nursing, 2005).
• Often situated within community nursing, global nursing
courses (Am. Assoc. of Colleges of Nursing, 2008).
• Nursing education has an emerging, but still largely
uninformed, understanding of the effects of service
learning upon nursing students.

6. Problem and Purpose
• To explore changes in affective – rather than cognitive --
personal development pertaining to empathy and caring.
• Quantitative research used a pre-test / post-test design,
concurrent with students’ first service learning experience in
nursing.
• Participants recruited from Nurses Christian Fellowship (ncf-
jcn.org) and Okla. Nursing Student Assn. (oknsa.org).
• Qualitative data gathered via student interviews.

7. 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).

8. Definition of Key Terms
• Empathy – Distinct literature in 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).

9. Definition of Key Terms
• Care – Infers “a concerned or troubled state of mind . . . arising
from responsibility” and “attentive assistance or treatment to
those in need” (American Heritage Dictionary, 2011).
• Care ethicists – see care in relational context.
• Caring is a process, a way of being with another that helps the
person develop into their full potential (Mayeroff, 1971).

10. Theoretical Foundations:
Noddings’ Ethic of Care (1984/2003)
• Care ethicist, from moral development and philosophy of education.
• Sees care as grounded in a relationship of the ‘Carer’ and the ‘Cared-for’.
• Both are to be equally respected, compatible with Martin Buber’s (1970) I and
Thou.
• Views caring as a nurturing, feminine posture.
• Caring is the 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.
• Within 10 years, a nursing theorist identified Noddings’ theory as a paradigm
for understanding the nurse/patient relationship (Crowley, 1994).

11. Theoretical Foundations
Katie 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 explored further: Eriksson, Peterson, & Zetterlund’s
(2006), The suffering human being.

12. Conundrum?
How to quantitatively measure affective outcomes
The
Softer
Side

13. 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 was the independent variable
 Empathy and care were dependent variables

14. 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 Morality in line with justice and
ethic of care (Gilligan, 1982) fairness (Kohlberg, 1971)
52 questions within seven ethical dilemmas

15. 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
15 questions

16. Research Questions
Q1. 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?

17. 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 would score higher in empathy and moral orientation toward care
after service learning).
Hypotheses

18. Data Summary
 Affected group: Those who anticipated having SL in the current
academic term (n= 81), with G* Power to determine significance
 Comparison group: Those who did not anticipate SL (n=179)
 Interviews: 11-12 students who self-identify as interested in
providing more detailed response. Qualitative descriptions
manually coded in several categories.

19. Responses – 26 Schools
East TX Baptist
Univ. of Mary Hardin Baylor
OU OSU
Univ. of Indianapolis
Univ. of Tulsa
SW OK State
Langston Univ.
Cedarville Univ.
Southern Nazarene Univ.
Mount Vernon Nazarene Univ.
OK Baptist Univ.OK City Univ.

20. Findings Emerge
 Statistical analysis underway via F tests and a statistical test of
MANOVA
 The Kruskal-Wallis non-parametric method for testing the sample
utilized as needed if the samples do not originate from a normal
distribution (Mayers, 2013).
 Interviews are concluding.

21. Limitations
 Service learning – does not allow for a separation of self-report
data (Bob Bringle, personal communication, May 13, 2015).
 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.

22. Empathy and Care Outcomes of
Service Learning In BSN Students:
A Mixed Methods Study for Nursing
Increased knowledge of service learning’s potential to shape the
caring attitudes of nursing students
John F. Martin, Ph.D.(c)
Oklahoma City, OK
www.forsterconsulting.biz
John@ForsterConsulting.biz