Abstract
Introduction
Undergraduate educators are increasingly called upon to serve community needs as an outcome of student learning. The growth of service-learning as an experiential strategy to promote meaningful outcomes for students and communities is an expression of this trend (Salam et al., 2019). The complexity of social problems, however, often transcends the scope of individual courses or even disciplines. Public health, for instance, operates at the nexus of social, medical, ethical, and environmental challenges, and thus benefits from creative transdisciplinary strategies to foster student learning and community outcomes. Despite the potential value that transdisciplinary service-learning presents students and communities, the reality of limited resources, the significant commitment of faculty time, and the expectation that courses meet disciplinary needs all pose challenges for course innovation in higher education.
Those barriers compound in service-learning and other experiential contexts. Although a dense literature on transdisciplinary, experiential, and service-learning supplies an array of case studies and best practices to develop pedagogies, most are premised on extensive planning at their outset (Bringle et al., 2013; Dunkel et al., 2011; Fink, 2013; Sorensen & Wittmer, 1996). These strategies are valuable, and our work neither undercuts their significance, nor precludes their later use. Yet this scholarship rarely provides the tools for faculty to develop effective teaching collaborations through pre-existing courses. Bridging pre-existing, independently developed courses have significant potential to transcend disciplinary differences, generate meaningful outcomes for students and communities, and generate data that instructors may use to enhance future collaborations.
This study explores the outcomes of a pilot collaboration between two faculty in the College of Nursing and Department of History at Creighton University in Omaha, NE. Each faculty member taught one course that focused on either the history or public health consequences of lead pollution and exposure. Like many teaching partnerships, the two instructors developed their courses independently, and each adhered to course- and discipline-specific expectations. At the end of the semester, faculty analyzed student reflection assignments in both courses to identify strategies that might deepen this collaboration in future semesters. This analysis identified six topics that showed the greatest potential to strengthen transdisciplinary teaching and learning. Collectively, these topics centered on what we describe as “Civic Health”—a framework for community organizing to solve public problems. We argue that instructors can enrich service-learning collaborations in nursing and history by employing a common exemplar, encouraging shared experiences in the classroom and at service sites, and employing a common concept (in our case, “Civic Health”) in shared curricula. Beyond nursing and history, our methods have broad potential to enrich transdisciplinary experiential collaborations between independently developed courses.
Background
During the Fall of 2019, two faculty in history and nursing taught two intersecting, undergraduate service-learning courses that explored the issue of lead pollution as a subject of population health and environmental inequality. The original partnership between faculty members was ad hoc. They were introduced through the university Office of Service-Learning prior to the semester. The history faculty initially sought a limited partnership, where the nursing faculty would visit the class to contribute outside expertise. These plans quickly changed after they discovered the amount of unplanned overlap between their courses. The foundational commonality was their use of the local environment as a common exemplar.
Borrowing from the concept-based curriculum in the clinical sciences, an exemplar refers to a case study that exhibits broader (and oftentimes multiple) social, environmental, and health-related pathologies (Schaffner, 1986). Omaha, Nebraska is an exemplar of the multidimensional problem of lead pollution in American cities. In 1999, the Environmental Protection Agency declared portions of eastern Omaha a Lead Superfund Site. Including twenty-seven square miles, it is the largest residential Superfund site in the country and the only one where people continue to live (United States Environmental Protection Agency, 2021). The city was home to the largest lead smelting and refining plant in the world, which operated for over 100 years and contaminated the soil in surrounding areas with lead particulates (United States Environmental Protection Agency, 2009). Homes in the Superfund site are also primarily residences built before the phase-out of lead paint in the 1970s.
As with many environmental and public health injustices, lead exposure disproportionately affects minority and low-income communities (Kraft & Scheberle, 1995). The communities living within the Superfund site encompass a wide variety of socioeconomic groups (United States Environmental Protection Agency, 2009). Current risk, however, is still heavily influenced by the historical legacies of segregated housing, road construction, and industrial emissions, which produced differential exposure to lead hazards in low-income and minority neighborhoods (United States Environmental Protection Agency, n.d.). The Superfund site has also been referred to as a medical desert due to the lack of access to healthcare providers (Sasse, 2019). Although lead exposure is complex and not limited to eastern Omaha, public health attention has historically focused on this area.
Beyond this common exemplar, faculty also discovered complementary approaches and objectives in their planned courses. Each course combined community-based service-learning experiences with in-class instruction. NUR472 Care Management and Outcomes Improvement Practicum III was a senior-level pre-licensure nursing clinical practicum. This clinical practicum provided an experiential opportunity for nursing care. Two clinical groups focused on a population-based public health approach to blood lead screening of children in early childhood education school settings. The course contributed to a community collaboration between two colleges of nursing, the public health department, and area public schools to monitor blood lead levels in students. As part of their service requirements, Creighton nursing students performed capillary blood lead screening with point-of-care testing under the supervision of faculty. Screenings took place in schools and at community health fairs across the city.
The second course was offered by faculty in the History Department. “The History of Environmental Inequalities” (HIS/EVS 483) was a senior-level undergraduate course that focused on the history and legacy of lead pollution and exposure in Omaha. In addition to conducting a semester-length research project on the history of lead pollution in the city, students participated in service experiences guided by a local nonprofit engaged in lead pollution advocacy and assistance across the city. The broader goals of these classes were complementary. NUR 472 introduced students to the social determinants of health through practical training, while students in HIS/EVS 483 explored structural inequalities in public health through historical analysis.
When the nursing faculty suggested that HIS/EVS 483 students partner with NUR 472 students during their lead screening practicum, the collaboration began in earnest. Nursing faculty visited the HIS/EVS 483 class to prepare them for the experience of lead screening. Her visit also introduced students to nursing perspectives on lead as a public health issue. HIS/EVS 483 students accompanied NUR 472 students to service sites, observed the lead screening process, and provided non-medical assistance when needed. Both service experiences encouraged interaction with peers and communities in Omaha at the greatest risk of lead exposure.
At the end of the semester, students in both classes completed written reflections on the experience. As with all features of these courses, faculty developed these assignments independently. The two faculty members shared the outcomes of these assignments and discovered remarkable congruity in students’ valuation of their experiences. They also discovered significant differences in student interpretations of lead as a public health hazard, its causal origins, their role as agents of change, and many other considerations. Most intriguingly, students in both classes commented unprompted on the value of sharing their service experience with peers from different disciplines. This discovery encouraged the faculty collaborators to refine their approach to encourage peer-to-peer learning and transdisciplinary engagement for future semesters.
Both faculty agreed that any future collaboration should draw upon scholarship and best practices in transdisciplinary education, service-learning, and nursing/public health education. These approaches were chosen because, collectively, they tend to emphasize collaboration, complex problems, community engagement, and critical reflection. Transdisciplinary approaches, for instance, bridge multiple disciplinary perspectives with collaborative, problem-based work based on shared questions, concepts, and lexicons to produce synergistic, holistic outcomes (Fam et al., 2018; Gehlert et al., 2010). Research demonstrates that transdisciplinary pedagogies foster the co-production of active and tacit knowledge among students, critical evaluation of disciplinary boundaries, and empathic reflection on complex social problems (Barth et al., 2014; Kaufman et al., 2003).
Service-learning, meanwhile, is a form of experiential learning intended to benefit both students and the community (Deeley, 2010). Models are diverse, but proponents broadly emphasize their potential in promoting multicultural competence and civic responsibility (Butin, 2010; Einfeld & Collins, 2008; Schuetze et al., 2019). “Critical” or “social justice” approaches encourage students to reflect on the roots of complex social problems, moral development, and the capacity of agents to affect change (Chupp & Joseph, 2010). Finally, public health nursing presented a useful body of scholarship that bridged transdisciplinary and service-learning approaches (Cashman & Seifer, 2008). In contrast to environmental history, nursing has long engaged in both approaches and existing literature provided useful themes and examples to interpret. These include themes like wicked problems and models like the concept-based curriculum.
It should be noted that both transdisciplinary and experiential/service-learning approaches have preexisting theories and taxonomies of learning, which are sometimes employed in course development (Butin, 2010; Ertas, 2000; Fink, 2013; Kolb et al., 2014; Müller et al., 2005). Our goal is neither to adapt nor critique these theories and exploring their intersection with our findings is beyond the scope of this article. We present, rather, a practical model that may be employed by faculty in preexisting service-learning courses to bring their courses into transdisciplinary convergence.
Methods
Faculty collaborators retrospectively analyzed de-identified student reflection essays based on their service experiences following IRB approval. Reflection assignments are frequently employed in service-learning because they encourage students to challenge their assumptions, fashion new frameworks of understanding, and foster agency and community engagement (Eyler, 2002; Hatcher & Bringle, 1997; Sanders et al., 2016). Although scholars have identified several techniques to evaluate learning outcomes based on reflection data (Ash et al., 2005; Barnes & Caprino, 2016; Molee et al. 2011), less work examines their use to develop transdisciplinary collaboration between service-learning courses. We approached our methods and analysis through the lens of concept-based curriculum principles common in nursing education, a framework designed to manage content saturation by concentrating on understanding broader principles (concepts) through categorizing and organizing information as exemplars to make systematic observations (Wolters Kluwer, 2017).
Instructors designed reflection assignments to meet discipline-specific combinations of content and service-learning objectives. The essay formats, prompts, and page length expectations were different between the courses. NUR 472 required two 300–400 word reflection essays, which in a class of 13 students produced 26 reflections. HIS/EVS 483 required one 1,200–1,500 word response from each of its 16 students. All reflection assignments asked students to consider the relevance of on-site experiences to the broader public health and environmental justice frameworks discussed in class. This commonality proved critical for later comparative analysis.
Grounded Theory
Grounded theory is a common methodology in the social sciences to gather and interpret qualitative data to develop a coherent theory of a social phenomenon through inductive reasoning (Charmaz, 2014; Chun Tie et al., 2019). Grounded theory has been used in both service-learning and population-health nursing research (Deeley, 2010; Singh & Estefan, 2018). The instructors chose this methodology because of its transdisciplinary applicability, suitability for qualitative analysis, appropriateness of fit for an unplanned retrospective analysis, and flexibility to accommodate internal variability in the student reflection corpora.
Instructors began their analysis with the following research question: what aspects of service-learning did students in both classes value? Work began with an initial round of line-by-line coding of all reflection essays to identify common themes and differences in experience and interpretation. The second round of coding and concurrent memo-writing broadened these findings into a set of themes that expressed the perceived value of the service-learning course components. Focusing on what the students perceived as valuable or meaningful in their courses not only helped the instructors critique their individual courses, but also identify areas of greatest convergence and divergence. These memos were also useful tools to interpret how and why similarities and differences emerged. Following the second round of coding, the instructors met to discuss and calibrate their findings, ultimately deciding on a suite of twelve general topics that instructors identified as important components of the shared learning experience.
Topic Modeling
Instructors coupled grounded theory with topic modeling using the natural language processing toolkit MALLET. Topic modeling refers to a semi-automated class of text analysis for coding the content of corpora into meaningful categories or “topics.” Topic models use computer-generated algorithms to identify word clusters with recognizable relational meaning (Mohr & Bogdanov, 2013). Topic modeling's quantifiable output is readily visualizable. One of the most widely used open-source topic modeling tools is MALLET, which uses the probability-based technique Latent Dirichlet Allocation (LDA) to examine word co-occurrence (McCallum, 2002). In the scholarship of teaching and learning, LDA has been used to analyze student forum discussions and reflection essays (Chen et al., 2016).
In topic modeling, one of the principal challenges is choosing the appropriate number of topics (K). If K is too large, the model will produce redundancy. If too few topics are assigned, the results will be too broad. Using grounded theory, we had already identified twelve distinct topics. We narrowed and refined our scope to ten using topic modeling. Our co-application of grounded theory and topic modeling worked synthetically. Topic modeling depends on a familiarity with text content that grounded theory supplies. Grounded theory is flexible and iterative and is thus suitable to verify computational results. Tuning topic models, in coordination with focused coding, produced a concise, visualizable set of topics from which a theory of relationships emerged (Figure 1). It also estimated the relative significance of topics. This hybrid methodology found that student reflections exhibited a high degree of similarity (+90%) across three sets of topics. Three additional topics were shared with a moderate degree of similarity (45–65%). The remaining four topics showed a very low degree of similarity (30% or less; Figure 2).
Topic modeling of EVS/HIS 488 and NUR472 reflection papers using MALLET, tuned through concurrent use of grounded theory coding, produced ten ‘topics’, or word clusters that exhibited a high degree of relational meaning. The MALLET output included the contribution of that word cluster to course-specific reflection papers. Figure 1 lists those ten topics in descending order, from greatest to least similarity calculated by percent difference in contribution to the combined corpora.
List of ten topics that show convergence or divergence between courses. Degrees of similarity (High, Moderate, Low) reflect percent difference in contribution to combined corpora.
Results
Despite varied experiences and learning expectations, student reflections revealed a remarkable degree of overlap about their experiences. The combination of grounded theory and topic modeling identified six topics of greatest converging meaning and value. Within those topics, however, important differences emerged. For instance, students in both courses expressed investment in service and the benefits of outreach in support of community partners, but their interpretations of “service”, “outreach”, and “community” frequently differed. To parse these meanings, the instructors returned to their coding memos and conducted another round of deep reading. Reasoning that an effective bridge between the disciplines will likely emerge from the experiences valued and shared by students to a moderate or high degree of similarity, this final stage of analysis employed close reading of reflection texts through those six topics. A clear pattern emerged that students in both classes overwhelmingly valued the service components of the courses as they related to public health, social justice, and direct contact with the community. These areas of greatest convergence contrasted with four topics that showed clear divergence.
Areas of Convergence
Valuing Service Education (Public Health)
Students frequently reflected on the value of service-learning as a format to engage with and intervene in public health issues. Students overwhelmingly shared a belief that service-learning pedagogy deepened their appreciation of public health work, but they differed in their interpretation of lead as a public health problem and potential interventions. These differences reflected the distinct disciplinary objectives of each course.
Nursing students tended to view lead exposure as a discrete health problem best addressed through a combination of community and medical intervention. They understood their service-learning experiences as medical training and interpreted the value of their activities through that lens. What we are doing, one student explained “is making an impact on not only finding children with high levels in their system and helping to stop any further damage.” From this perspective, lead screening was preventative care. Students readily acknowledged the importance of community partners as well. Students were quick to emphasize that effective preventative care required collaboration between medical specialists, public health organizations, and families.
History students valued their nursing peers’ contributions but viewed lead exposure as one part of a matrix of socio-environmental issues that required broader intervention. Some criticized public health interpretations of lead as overly narrow. “It's cliché to say but I still feel the public just doesn’t see how big of a problem this is.” Public health, “as progressive as it is, is simply not enough to effectively and significantly change the lead crisis as it is today.” These students viewed the public health hazard of lead as symptomatic of other social and environmental injustices. Their interpretations of public health interventions were correspondingly broad, ranging from education and outreach to direct action. Some students interpreted lead screening itself as an important expression of activism. “I view my experience,” one student declared, “in a similar light to this resistance. I believe these organizations continue to carry out a similar mission to other movements by attempting to ensure environmental justice is provided to all in our community.” Lead screening, from this perspective, was an important intervention in the landscape of not only public health, but also environmental justice.
Valuing Contributions to the Community
Students overwhelmingly valued the opportunity to contribute service to the community, but their interpretations of that service varied. This was partly due to the course-specific expectations. Students in NUR472 conducted lead screenings and engagement with target populations was a course expectation. Students in EVS/HIS483 observed and provided non-medical assistance when appropriate. The degree of their direct interaction with children varied depending on the student. Instructors designed the service experiences to produce different outcomes and student reflections revealed those differences.
Both sets of students believed their experiences contributed to community outcomes, but for different reasons. NUR472 students tended to focus on practical contributions to public health. They valued the opportunity to “share our nursing skills and offer fairness in medical treatment and resources.” I am grateful, another reflected, that “we are able to perform these lead and hemoglobin screenings for these children because we are able to advocate for them and work to protect them from these significant issues that occur in their community.” In the context of the course, their nursing skills developed into a form of direct advocacy.
Students in EVS/HIS483 also highlighted the value of advocacy, though they tended to focus on education and outreach. Several students attended a local community health fair and were surprised to discover that few families requested free screenings. Whether due to language barriers or lack of information about lead risk, they concluded that more effective outreach was required. Others argued that education about lead should extend beyond health risks to involve “the complex, interconnected web of factors that determine an individual's health, wealth, and social standing.” “There needs to be an educational component that delves deeply into why this specific area is requiring a specific service,” another said, “it does no one any good if history negatively repeats itself.” Advocacy involved increasing public access and engagement with information about the structural roots of inequality.
The distinction between these forms of advocacy did not break down cleanly by course. This partly explains the high degree of similarity within this topic (Figure 2). Many nursing students also focused their reflections on the importance of education and outreach. Similarly, the history students noted how lead screening was a form of preventative care that required greater public support. Regardless of how meaningful they considered their direct contributions, virtually all understood that the challenge of lead exposure required greater personal and community advocacy in the future.
Valuing Personal Development
Student reflections in both courses often began by contrasting their preconceptions about lead screening with the actual experience. This unprompted trope highlighted the value students attributed to personal development. Lead screenings took place in neighborhoods few students had encountered before. Students were struck by the racial, class, ethnic, and linguistic diversity of the city. “This clinical rotation has been eye opening for me,” one nursing student began, “I feel that I was able to gain a more encompassing understanding of the Omaha area as a whole.” Nursing students explicitly translated similar insights into justice-inflected language. “Because there has been such a wide array of the student populations in regards to race, background, and even mental disabilities, we have been able to see the importance of the nurse competency to demonstrate non-judgmental/unconditional acceptance of people,” another student concluded.
Students in EVS/HIS 483 likewise emphasized their greater appreciation of Omaha's diversity. Some attributed their surprise to their own immobility. “I had focused so much on [my own] community that I had remained ignorant of problems just outside my front door,” one noted. Another student expected that her Spanish language skills would prove useful when volunteering at a public health fair but was shocked to discover the primary need was translation into Burmese. Students had learned earlier in the class that lead exposure is disproportionately acute in some refugee populations, but direct contact with these communities in Omaha reinforced that reality.
Students in both classes likewise valued lead screening work because it humanized a complex problem they had only understood theoretically in the classroom. “I think there is a disconnect between written research on current issues and the ability to empathize with the issue. We…tend to lack the drive to correct issues if we are not personally impacted ourselves, even if the problem is given enough awareness,” one student reflected. For some, it left an indelible emotional impact. One student remarked how moved she was to see a mother's expression change when she understood her translator's use of the word “toxic” during a lead screening. For others, the experience was empowering. It was one thing to learn about environmental hazards, one nursing student noted, but after “seeing them firsthand in the children screened” they felt convinced that “they have the ability to bring about change.” Finally, encountering public health problems in unfamiliar environments reinforced the challenge of addressing complex issues. Service-learning transformed theory into reality and convinced many students their work was “relevant.” Their work fostered deeper understanding of unfamiliar communities and empathy for people they encountered, but also underscored the challenges and limitations of the practice.
Valuing Service Education (Social Justice)
Service-learning and social justice education are pedagogically distinct, yet studies increasingly promote their integration (Butin, 2007). Among other benefits, combining the two approaches encourages students to examine their own social positions and question the roots of inequalities to promote justice-oriented change. One significant shared theme in reflection papers was their own privilege. Students in nursing and history tended to frame the meaning of their privilege differently, however.
History students tended to frame themselves as “well-meaning outsiders,” a characterization that at once reflected their roles as observers during lead screenings and encouraged them to assume a synoptic gaze over the problem of lead pollution. They were quick to point to the socioeconomic, gendered, and racial dynamics at play. A few explicitly noted their own complicity in perpetuating these structures, but most reflected that their privilege had shielded them from this awareness, especially during previous service experiences. “Although I… volunteered for 3 years at a hospital located in a lower socioeconomic region of Des Moines,” one student noted, “I never once considered how injustice and related inequity may be affecting the people around me.” In general, their thinking showcased a transition from a “charity paradigm” in service education toward a “social change paradigm” (Einfeld & Collins, 2008).
Nursing students also tended to identify themselves as outsiders, though their privilege translated into skills that implicitly set them apart from people receiving care. Many reflected on the population-health characteristics of communities, including poverty, race, and refugee considerations such as cultural and language barriers. In general, nursing students acknowledged that their social positions and nursing training lent them unique skill sets that might prove useful to promote social justice work. “Knowing that many of the children that we are testing come from families with lower socioeconomic statuses provides me with an opportunity to care and provide education about lead exposure to these families so that they may live with their best quality of life,” one student noted. “Everyone should have access to healthcare,” another student concluded, “no matter their socioeconomic status, race, or ethnic background.” Social justice was an important outcome in both courses, yet the differences in student reflection revealed divergent interpretations of their own privilege.
Valuing Work by Community
Students in both courses also reflected on the value of practiced and observed leadership within the community. Qualities of leadership identified by students included inspiring work by individuals, the impact individuals had on populations, learning by observation of others, and principles of social justice. Although no student used this specific language, they were expressing the qualities of “servant leadership.” A servant leader shares power, putting the needs of others first and focusing primarily on the growth and well-being of people and the communities (Robert K. Greenleaf Center for Servant Leadership, 2016). Student reflections on the perceived value of servant leadership showed remarkable similarity across both courses.
Both sets of students observed servant leadership in action. The service activities of nursing students necessitated close cooperation with numerous stakeholders, and many reflected on the value those collaborations produced. Their observations resulted from direct engagement. Reflecting on the role of servant leaders, one history student noted, “they’re not doing service in a community; rather, they do service alongside it.” Others emphasized skill development essential to their education. “It was working with community members and the service component of the class that kept the material we learned about grounded and relevant,” another stated. Students from both courses spoke of being inspired by individuals doing work that impacted the community.
Seeking Causal Origin of Hazard
Student reflections in both classes showcased the value of understanding the origins of the environmental health hazards. Although “lead” was universally understood to be the proximate cause of health problems, students connected exposure to a broader set of social conditions. Students once again never used this term, but they identified lead exposure as a quintessential “wicked problem.” Wicked problems, as described by Kreuter et al. (2004) are complex issues wherein stakeholders have conflicting interpretations of the problem and the science behind it, as well as different values, goals, and life experiences. Studies of lead exposure have characterized it as a wicked problem, and student reflections confirmed these findings (Caron & Serrell, 2009).
Students in EVS/HIS 483 most often characterized the wicked character of lead in systemic racial and economic terms. “Lead contamination and the populations exposed are not random—there are systemic patterns behind it all,” one student stated. Lead, from their perspective, was symptomatic of broader social and environmental inequalities that transcended public health. NUR 472 students, by contrast, identified the problem as a gap in access to health care. Lead exposure was “a medical matter—an unfair health risk that these children were subjected to,” one reflection noted. Although restricted to its medical context, nursing reflections acknowledged these problems remained complex and embedded in a wide array of political, financial, and social complexities. For many, the “wicked” character of lead exposure reinforced the importance of public health work and social and environmental activism.
Areas of Divergence
Areas of convergence represent topics with a high potential for improved shared learning outcomes, but four additional topics indicate areas of significant divergence. Divergence primarily reflected discipline-specific objectives. Although it may benefit transdisciplinary collaboration to narrow this divergence in some cases, discipline-specific learning outcomes remain expected and essential to meet course and program objectives.
Connecting Care to Social Conditions
Although both sets of students emphasized the importance of social conditions as causal origins of lead hazards, nursing students overwhelmingly directed this awareness to the conditions of care. The nursing instructor privileged this interpretation by assigning students “windshield surveys” to assess community environmental conditions and trends that might affect public health (Callan, 1971). Their emphasis on the social dimensions of “care” was an expected outcome, explained by curricular emphasis on Jean Watson's Theory of Human Caring, a framework for the practice of nursing that embraces art, science, humanities, and spirituality to examine the human phenomena of nursing practice (Watson Caring Science Institute, 2021). Very few history students made this connection. From their perspective, lack of nursing care was not the preeminent service deficit.
Valuing Practical Nursing Skills
Nursing education traditionally emphasizes technical nursing skills. Nursing students overwhelmingly valued this approach, which included capillary blood collection, laboratory machine use, data interpretation, and interprofessional collaboration. Surprisingly, some history students also commented on these nursing skills, emphasizing the value of shared experiences. “I was also able to learn a lot about the social and medical issues surrounding lead in Omaha from the nurses who were performing lead screening tests,” one student noted. Another valued the shared small group setting, noting, “by participating in a lead screening in a smaller, less busy setting, I was able to better understand the process of lead screening. Seeing it at that scale, I was able to see the care and passion that the nurses put into their work.” The lead screening sites offered environments for shared teaching as much as learning, with one student commenting, “I learned the most while I was talking to the nursing students between [lead screening] groups.” Although the value attributed to practical nursing skills understandably favored nursing students, it also indicated that lead screening sites fostered peer-to-peer learning.
Connecting Social to Environmental Justice
Another area of clear divergence was the emphasis students placed on environmental justice. Both classes included students that reflected on the “environmental” and “justice” implications of lead exposure, however, the clearest and most consistent treatment of these themes appeared in HIS/EVS responses (Figure 1). This was unsurprising because EVS/HIS 483 students were expected to seek connections between lead as a health risk and environmental justice issues. Importantly, the concept of environmental justice did not appear in NUR 472 coursework, yet some students still made these connections based on their shared experiences with peers. “I got to learn about and explore a topic that affects my community that I had no idea existed,” one offered. “Environmental justice is an important ethical issue.” Like practical nursing skills, environmental justice was a clear topic of divergence that highlighted disciplinary/curricular areas of emphasis, yet evidence of peer-learning appeared.
Observing Community Work
A final topic of divergence was the value of observing community public health work. Whereas history students consistently emphasized the value of observing community partners, nursing students emphasized their practical engagement with community partners (Figure 1). These patterns resulted from the different learning outcomes built into these two courses. NUR 472 encouraged students to see their service as a direct contribution to a public health program. EVS/HIS 483 framed observation as a structured opportunity to “encounter, serve, and form relationships with individuals and communities that might otherwise remain outside their personal experience.” “Bearing witness” to injustice encouraged history students to value observation as a strategic tool (Dunn, 2014).
Discussion
Our analysis of reflection assignments, grounded in scholarship at the intersection of transdisciplinary, service-learning, and nursing/public health education, revealed four broad conditions that fostered shared student learning: a shared concept, exemplar, experiences, and objectives.
Shared Concept
Student reflections displayed high or moderate convergence around a set of six topics identified through our combination of grounded theory and topic modeling. These topics are constitutive elements of “Civic Health.” The National Conference on Citizenship defines Civic Health as “the manner in which communities organize to define and address public problems” (2019, para. 6). Civic Health involves transdisciplinary research and collaboration, and as a concept in curriculum, interprofessional courses can facilitate civic mindedness by bringing together key stakeholders in the community to identify and address the issues they care about through examination of an exemplar through service-learning. Transdisciplinarity depends upon just such a “shared conceptual framework” (Slatin et al. 2004). It links academic service-learning in public health to community building, critical evaluation of public institutions, and civic engagement. These were precisely the themes that showcased the greatest convergence between NUR 472 and HIS/EVS 483.
The unifying language of Civic Health connects their learning experiences to larger civic contexts and their own responsibilities. “We must also remind ourselves to keep up with issues and risks that are posing threats to the community,” one student noted, “and to also educate ourselves on how to find new solutions to problems that may be arising over time.” Other students had their first opportunity to witness the importance of community building, commenting, “learning the importance of these relationships within the community allowed me to realize how much our success with this program is based on the relationships built and how they are maintained.” Further, students examined how these relationships extend beyond the community health program itself, commenting, “The populations I have come across in this rotation have shown me that there is an imperative need for individuals who represent and act on the ‘greater good’ on behalf of those who need such advocacy.”
Students also critically evaluated public institutions and civic engagement. “The lead screenings I have partaken in have provided opportunities for underrepresented populations to get necessary and effective, preventive care,” one student noted, “…individuals of power have put a blind eye to this issue due to politics and special interests. Such populations have been the victims of a system that prioritizes business principles over social justice… This element made the clinical mean so much more than just training to become a nurse.” Another noted that “Something that has stood out to me though this clinical is the statement that community health is a public health issue-it IS political. At the root of these issues (lead poisoning and more), money and unequal representation among those who are suffering in non-habitable living situations do not get the systematic change needed. Community health is so important because there is an ability to incorporate higher system thinking into communities in order to promote change for many.”
Instructors could enrich the Civic Health outcomes of shared student learning by promoting Civic Health as a formal concept for shared curricular development. Civic Health could operate as an umbrella concept that incorporates other useful language and theories—including wicked problems, servant leadership, advocacy, and the social determinants of health. This may include introducing learning modules on the subject and incorporating Civic Health into reflection assignments. As a concept for collaborative learning, students could examine Civic Health indicators (i.e., volunteering and giving, group membership, trust in institutions, social interactions, neighbor connectedness, voting and registration, and political involvement) in relation to population-based care, health policy, ethics, and finance, as well as historical changes in these themes. Examination of social change leadership, analysis of civic-related research, and exploration of civic identity will promote student agency, encourage empathetic discernment, and foster advocacy as healthcare professionals and educated citizens.
Shared Exemplar
Focusing on the common exemplar of lead exposure in Omaha presented students with a shared set of problems and a common pool of data/resources. When combined with the concept “Civic Health” the history and public health implications of lead transform from abstract ideas into real-world impacts that engage students (Wolters Kluwer, 2017). Organizing work around local issues encouraged student advocacy, community solidarity, and feelings of agency. To strengthen shared learning, instructors could develop a common set of resources specific to this partnership. These resources would emphasize relevant themes that emerged in unrefined form in reflection papers, such as wicked problems and servant leadership. Instructors could also formalize transdisciplinary relationships by visiting classes, sharing texts/resources/shared library eReserves, and collaborating on future projects such as a digital repository for literature review, data collection, and student and faculty research.
Shared Experiences
Learning took place in classrooms and in the community, led by instructors and community leaders. The most significant shared learning took place informally in on-site discussions between student groups. This confirms recent scholarship indicating that peer-to-peer learning magnifies the civic benefits of community-based projects. (Mitchell et al., 2016). These experiences also helped reinforce the value of their own disciplinary content as well as the impact of their overall experience. One nursing student put it best: “The group I was fortunate enough to work with were amazing in that everyone shared a passion for children and displayed a sense of pride in social justice. It made the clinical environment positively contagious and productive which made the setting an exciting place to learn and grow.” These peer-to-peer interactions were ad-hoc and unstructured and yet they generated among the most insightful and surprising conclusions in reflection essays. Instructors could leverage shared experiences to foster transdisciplinary thinking by formally encouraging student interaction at screening sites. Instructors could also introduce opportunities for shared reflection, align classroom schedules to encourage joint sessions, or host a mini-conference.
Shared Objectives
Service-learning depends on collaborative, mutually beneficial relationships between students and community members (Cashman & Seifer, 2008). Beyond screening activities, visiting service sites and interacting with community members provided a shared set of objectives that fostered cultural competency, awareness of social location, empathy, and servant leadership. Shared objectives could be enhanced with a common concept-based curriculum, including shared language and information to deepen learning experiences and understanding. To encourage further shared student learning and strengthen confidence in future comparative analyses, instructors could (and should) design guided student reflection activities with common or identical questions. Additional transdisciplinary learning could occur through instructional/classroom experiences, including collaborative work on a digital lead history portal (currently an outcome limited to EVS/HIS 483 students), expanded opportunities for community visits/observations, a common set of events featuring guest speakers, and other overlapping theory instruction where applicable.
Beyond Nursing and History
The benefits of our method to identify areas of converging value between independently developed service-learning courses extend beyond nursing and history. The identification of shared concepts, experiences, and objectives is a useful first step to developing transdisciplinary coherence regardless of the course. These ambitions are mutually reinforcing. Common concepts supply shared language and objectives around which critical interpretation of shared experiences coalesce. In the context of shared experiences, students recognize the promise and limitations of their agency in collaboration with community partners. Shared objectives supply a common purpose, which reinforces the value of shared concepts and their experiential learning activities on the ground. Our collaboration also benefitted from a common exemplar and a corpus of reflection papers assignments supplied the data necessary to identify topics of converging value. The latter is a common artifact of many experiential learning courses, though any written assignment that encourages students to think critically about their experience and its value could potentially serve a similar approach. The common exemplar was also prerequisite in our case study, although similar collaborations might emerge out of completely different contexts or focus on different social problems. Although our analysis pointed to transdisciplinary opportunities specific to public health, our methods are not limited to this subject. Indeed, our hybrid approach is conducive to any curricular innovators who wish to build or broaden transdisciplinary collaborations to enrich the student experience.
Conclusion
This analysis demonstrated that shared student learning in history and nursing can be fostered by focusing on a common exemplar, incorporating service expectations in shared locations, and promoting student reflection based on their shared experiences. Student reflection also revealed that shared student learning may be further encouraged with the development of a shared concept of interpretation, in our case Civic Health. Although this study focused on the outcomes of a specific partnership between undergraduate history and nursing courses that focused on the public health implications of lead exposure, its broader conclusions likely apply across the health sciences and humanities.
Our hybrid method to identify areas of convergence in order to promote greater transdisciplinary collaborations may also have broader appeal. Transdisciplinary teaching and learning often benefit from close collaboration at every stage of development, including course design and management. Many collaborations emerge organically, however, either in the process of teaching or after the completion of the semester. In this latter context, our methods and analysis indicate one strategy instructors can employ to identify opportunities for greater transdisciplinary synthesis in the future. Perhaps just as often, course collaborations begin (like ours) as “multidisciplinary” partnerships that largely retain their narrow disciplinary lenses and obscure their shared meaning (Gehlert et al., 2010). Our hybrid grounded theory/topic modeling approach identified topics that displayed broad commonalities in meaning, but just as importantly, it highlighted the different interpretations of those topics. Working through those topics presented important insights into potential strategies to bridge disciplinary differences and foster shared student learning.
These insights are more pressing than ever as universities develop strategies to integrate student experiences in the liberal arts with professional education. Our study indicates that disciplines spanning this divide often complement each other. Nursing, for instance, has long fostered extensive experiential opportunities for its students, but instruction is often siloed within nursing scholarship and focused on skills-based outcomes. History, by contrast, focuses less on skill development and history students typically have fewer experiential learning opportunities than their nursing peers. History trains students to identify patterns in causation and to evaluate the significance of power and privilege over time and varying spatial scales. Each approach has independent value in public health education, but transdisciplinary approaches to experiential education promise an outcome greater than the sum of its parts.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article
