INTRODUCTION:

The effective management of community and health promotion programmes requires evidence-based education and implementation strategies¹. Nursing education with a perspective based on community should be in a way that it can supply contact with the community to which its undergraduates will render service². Following health system reforms in Turkey, primary health services have started to be provided by family and community health centers. As a member of the health service team, nursing has encountered new difficulties following the changes in the health system. In community health centers, nurses are going to have active positions in the provision of health services for workers.

Nurses should be educated according to their changing conditions and circumstances in order to reach these targets and fulfill the roles at issue and they must improve their education in this regard³.The target issues to be learned by students are firstly to be aware of the environment in which the service is afforded, secondly to describe its conditions, thirdly to establish the connection between service and academic learning goals and finally, to learn their roles as health service providers in the future³. The basic features of SL are arranged below:⁴

1. Nursing undergraduates learn service by active participation in which the community and school come together as a team consisting of daily social requirements and carefully organized service experiences and nursing undergraduates develop themselves in this way ⁵.

2. Reflective practice in which undergraduates consider the things they see and do during the events they play a role in, discussion and composition are components of their education programme⁶.

3. Service to the community ensures opportunities for undergraduates that are necessary to help them cope with the new information and skills in real life conditions that they take part in ⁷ .

4. Service work continued out of class and within the community helps undergraduates develop the sense of being aware of other people and supports their learning process at university ⁸.

The health high school curriculum covers subjects such as thepromotion of workers’ health and its development in line with fundamental health services and community health philosophy, the detection of workplace risks, and a course which describes the role of nurses in occupational health services with regards to multidisciplinary team understanding.

This course made up of 60 hours’ theory and 120 hours’ practice was applied to a group consisting of 22 students. Within the context of this course, occupational health promotion intervention was implemented via an SL approach. The approach under consideration was preferred since it is a strategy to increase the effectiveness of interventions for the protection and development of health in the workplace and nursing is a social accountability occupation ⁹.

The purpose of this article is to describe service learning implementation in Nursing undergraduate occupational health practice and to show how it can be applied to improve occupational safety and health

Development of Educational package

Identification of Beauty salon worker health education needs

Beauty salons in Bornova were visited by student groups consisting of two or four individuals to evaluate the working conditions and encountered risks. During these visits, workplace status determination forms were filled out by interviewing personnel, and negotiations were held with the representatives of the guild of hairdressers and the authorities of the municipality. Students prepared reports which determined definitive characteristics of the personnel working at beauty salons and the risks that they confront by making use of the data obtained in this process. It was determined that manicures and pedicures are performed in 109 beauty salons out of 211 registered to the guild of beauty salons and 131 individuals work at these places in the Bornova region. It was detected that the age of these individuals ranged from 20-35 and their education level was secondary school and high school level. As the literature mentions, manicurists/pedicurists are in the risk group regarding viral hepatitis and they should protect themselves and the clients ¹⁰. unfortunately, as a result of the observations the students carried out, it was established that hygiene conditions such as hand washing, disinfection, sterilization, personal protective supply use are not adequately taken into consideration. Hand washing was not performed before and after each service, mostly ineffective disinfectant solutions were used for disinfection. In many salons, ultraviolet cabinets, which are not recommended, were used for sterilization. Workers didn’t wear gloves, gown and face screens or mask during each service. In the interviews carried out with the personnel at beauty salons and the authorities of guild of hairdressers; it was particularly stressed that no worker was under the control of occupational health services so periodical controls (medical examination, immunization) were not performed. In 2009, Ministry of Health (MOH) defined the manicurists and pedicurists as risk group for blood borne infections and Hepatitis B vaccine was provided to those who applied to community health centers without any payment ¹¹. Although the guild directory had given advices on the appropriate use of sterilization equipment, the improvement didn’t occur. They also informed their memberships about the circular of the MOH on the immunization. Unfortunately, much of the workers in the salons visited weren’t immunized against Hepatitis B. These interviews provided students with the experience of workplace observation and a link to worker attitudes in the course of learning about the nature and consequences of workplace risks.

Following this study, the students conducted a literature review associated with importance of bloodborne infections, the risk factors, the risk groups and how the infections spread. The students were asked what prevention measures could be taken. It was decided that being one of the most influential intervention approaches in protection and prevention, a face-to-face education programme devoted to beauty salon staff should be prepared. Consequently, students experienced an occupational health intervention and assessed occupational health promotion resources available in the workplace and compared these with best current practices cited in the literature.

Determining the purpose and targets, instruction plan and activities

The targets of the education package to be prepared were identified as acquisition of accurate behaviour such as knowing the mode of illness transmission, convenient decontamination, knowing and performing sterilization methods, and having vaccinations and use of personal protectors. The students were asked to prepare a presentation involving these educational aims for the following class by dividing into five groups. In the next session, all presentations were shared and a collective standard presentation was formed including learning targets thanks to overall presentations.

When it was decided to carry out the education process face-to–face, the students thought of transforming the most appropriate presentation into flip charts and it was decided that each slide should be on one page and that there should be instructions on each back page in order to standardize the education (standard visual guides).

Service-Learning Intervention

To realize the intervention, the faculty made contact with the guild of hairdressers. The guild of hairdressers undertook the assignment to make a list of registered beauty salons, and to make an announcement for students to inform the workplaces and print the prepared flip charts. The course programmes were applied at beauty salons by student groups made up of two individuals and some questionnaires examined the knowledge level of preschool education and behaviour. Coloured printed flip charts were utilised in the education process and brochures containing information concerning sterilization and the mode of transmission of diseases were left at the salons and people were also informed about where they could receive vaccinations. The students were accompanied by the faculty and the delegates of hairdressers chamber. Some of interviews were recorded and shared with other faculty members and students. Information about the project was released to local media. Workshops were carried out to facilitate the implementation that they had achieved during face-to-face education for manicure and pedicure staff under the guidance of the guild of hairdressers and its significant support.

Evaluation

The course was evaluated in two parts. In the first part, the efficiency of intervention which was performed was measured through outcome evaluation. A questionnaire was carried out to determine the changes seen in the knowledge of the staff and their long-term attitudes prior to education and for the following Three months after the education through face-to-face interview techniques. The mean knowledge and attitude scores had significantly increased after the education, from 17.0±2.1 to 17.6±2.6 (t=-2.113, p=0.038) for knowledge and from 7.8±2.5 to 8.9±2.8 (t=-3.230, p=0.002) for attitude. Significant increases were observed in four of the attitude items: the Hepatitis B vaccination rate increased from 68.4 per cent to 77.6 per cent hand washing rate before and after each operation increased from 55.8 per cent to 70.1per cent, avoiding cleaning equipment with an open wound ascended from 47.2 per cent to 69.4 per cent and recommending the clients to bring their own equipment escalated from 68.8 per cent to 88.3 per cent (p<0.05). An individual face-to-face education for manicurists/pedicurists, given by undergraduate students with the aid of a standard visual guide effectively increased the knowledge of manicurists/pedicurists and improved their infection control practices.

In the second part of evaluation, students’ feedbacks were taken as the educational process evaluation to determine their satisfaction. After this service learning experience, students stated that they had gained skills such as diagnosing the workplace in terms of workplace health, evaluating the working conditions, interviewing employees and evaluating the risks they face, and the ability to plan and apply an occupational health promotion regarding employees’ health protection behavior and attitudes. They also expressed that they had had the chance to get prepared for their future role as health workers and earned trust by accomplishing a social responsibility during the SL. Students indicated the following as the difficulties they met during SL:

- The workers had trouble to spare time for the face-to-face training

- It was sometimes not possible to reach the same employees for after-training evaluation purposes since the turnover rate for beauty salons is reasonably high.

As recommendation to improve SL efficiency, faculty, media and municipality could rise the awareness of beauty salon owners before the intervention.

CONCLUSIONS:

SL strategy was useful to develop and present an occupational health education offering on-the-job-related infectious disease prevention on behalf of workplaces. This experience, in addition to linking the service experience to course objectives, will enable students to shape her/his development as a sensitive and skillful nurse-midwife. SL was utilized well and the benefits for the students and community were powerful. It changed behavior for the students and the community (manicurists/pedicurists). The increase in infection control awareness as well as implementation of procedures and compliance were the gain of SL approach. Furthermore, the cooperating foundations were able to get the aid they required, and the faculty members had the chance to experience the learning approach in a real life environment. Students, lecturers and workers had the opportunity to work together to achieve meaningful learning and application results.

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Received on 15.08.2013 Modified on 10.10.2013

Asian J. Nur. Edu. & Research 4(1): Jan.-March 2014; Page 01-03