Environmental Sustainability-Focused Service-Learning for Nursing Students

Background: Sustainability is increasingly defined as a professional competency in nursing education; however, awareness does not necessarily translate into daily and professional behavior. Service-learning integrates academic learning with community service and structured reflection, yet experimental evidence on its effects on sustainable consumption behaviors and sustainability attitudes in nursing students is lacking.

Design: Pretest-posttest randomized controlled trial with an active comparator and a 10-week follow-up.

Setting and participants: The study is conducted within the compulsory Community Awareness Project Course (Toplumsal Duyarlılık Projesi) in the fourth year of the undergraduate nursing program, Faculty of Health Sciences, Acıbadem Mehmet Ali Aydınlar University. All students enrolled in the course in the 2026-2027 academic year (approximately 76) are invited.

Randomization: As part of routine course practice, students are randomly assigned to pre-selected NGOs using a computer-generated random number list. The list is generated by a researcher not involved in course assessment, and allocation is concealed until assignments are completed. Students work in project teams of approximately 7-8 per NGO (individually randomized, group-delivered design); approximately 30-32 students are expected per arm.

Interventions: Both groups complete the same 14-week structured service-learning process: meeting with the assigned NGO, identifying its needs, and developing and implementing a student-led project with structured reflection. Course duration, in-class teaching hours and content, project development steps, team size, form and intensity of faculty mentoring, reflection activities, and assessment criteria are identical across groups. The intervention group works with environmental sustainability NGOs (e.g., waste management, air quality, marine and coastal protection); the active comparator group works with NGOs in health and social fields. Each team's NGO meetings, project activities, and participation in reflection activities are monitored by faculty mentors and recorded on course forms.

Outcomes: Primary outcome is sustainable consumption behavior (Sustainable Consumption Behavior Scale; Doğan, Bulut \& Kökalan Çımrın, 2015). Secondary outcome is sustainability attitudes in nursing (Sustainability Attitudes in Nursing Survey-2, Turkish version; Gürgen Şimşek, 2025). A descriptive information form collects demographic characteristics and prior sustainability, volunteering, and service-learning experience.

Sample size: Because all eligible students are invited, no a priori sample size was calculated. With 32 participants per group, alpha = 0.05 (two-sided), and 80% power, the minimum detectable effect size is Cohen's d = 0.65; accounting for clustering within project teams (ICC = 0.05, mean team size 7.6, design effect 1.33) it is d = 0.75, and adjusting for baseline scores (r = 0.60) it is approximately d = 0.60.

Statistical analysis: Linear mixed-effects models will include time, group, group-by-time interaction, and type of study program as fixed effects, and student and NGO as random effects. The intervention effect will be assessed by the group-by-time interaction and reported as adjusted mean differences, standardized effect sizes, and 95% confidence intervals (p < 0.05).

Ethics: Participation is voluntary and independent of course grades. To minimize perceived coercion, consent and data collection are conducted by a researcher not involved in teaching or grading; course instructors have no access to consent status or responses until final grades are confirmed.