Bringing health care to marginalized populations can be a difficult business.

Many elderly people are prevented from seeking regular checkups due to isolation and a lack of mobility, while homeless persons often have no regular practitioners or health insurance and may have trouble trusting authority figures--medical or otherwise. Compounding the problem, many health-care professionals, especially those beginning their careers, have little experience in caring for these individuals and may not be responsive to their specific needs, experts say.

To help remedy this situation, the CHNS Nursing Center is hosting a program called "Promoting Healthy Lifestyles in Delaware," a screening and education initiative that aims to provide health care and awareness to the vulnerable populations that are most in need of it. Funded by a grant from the Bureau of Health Professions' Division of Nursing in the U.S. Public Health Service's Health Resources and Services Administration, the program prepares UD nursing students to meet the needs of under-served individuals through clinical practice and education.

"This is not a new idea--going out into the community," Bethany Hall-Long, associate professor of nursing and clinical coordinator for the project, says. "But, the grant is enabling us to do more screenings and then do educational follow-ups."

In addition to Hall-Long, the project's team includes principal investigator Lisa Plowfield, who is the nursing department chairperson and a Hartford Institute Geriatric Nursing Research Scholar, and Evelyn Hayes, professor of nursing and the project director.

Since its start in January, the program has brought senior nursing students into the community to work with elderly and homeless persons on a variety of health problems, including diabetes, cardiovascular disease and cancer. In addition to the stopgap solution of merely screening individuals for what already may be advanced medical conditions, the students also have been educating participants on preventive measures. They are providing instruction on proper nutrition, exercise and breast cancer self-exams--programs that even the most well-staffed centers often require outside assistance to offer on a regular basis.

"The blood pressure screening was very helpful," Bonnie Andruszka, program director at Graham Senior Center in Wilmington, says. "Our regular blood pressure screeners had to leave us for a while due to a lack of staff, and it was wonderful to have the students."

Graham's executive director, Susan Sawyer, adds, "Without their partnership, we would have had trouble doing all the programs we would like to offer."

According to Hall-Long, the program has screened more than 600 individuals at a multitude of different sites since its inception. Under her direction, UD nursing students referred several participants immediately to the hospital and many more to their general practitioners.

Hall-Long teaches a certificate program to undergraduates, "Care of Vulnerable Populations," through the nursing department. The Promoting Healthy Lifestyles initiative is integrated within this program and another senior-level nursing course. Students are trained in cultural competence and health promotion theory in a classroom setting before going out into the community to apply their knowledge firsthand.

"Our students gain real-life experience in dealing with difficult and often complex health and lifestyle issues," Plowfield says. "In turn, the community gains. Services are provided to groups who might otherwise not receive any health care or education."

She says this dual focus is especially timely in light of the increasing challenges the health- care system faces. A spiraling number of elderly patients has been coupled with a shortage of health- care personnel, resulting in understaffing and stress in many facilities. Those who do enter the profession often have a choice of jobs, and experts say they may shy away from working with the elderly or disadvantaged due to a lack of exposure to those populations.

According to Hayes, programs such as Promoting Healthy Lifestyles can help fill this gap by giving students an appreciation of the meaningful work they can do with such populations.

Sandy Anderson, activities director at the Wilmington-based homeless shelter Sojourner's Place, says, "Many of our clients have been living very unhealthy lifestyles. They have drug and alcohol problems. The nurses not only do presentations, but they interact with the patients and build relationships. Many of the homeless patients have problems with trust. The nurses build up trust, and the patients confide things in them that they wouldn't confide in a doctor."

Supporting the work done by the students are two part-time community outreach workers, who were hired through the grant in late spring to help identify needs in the communities the program serves.

"They visit the sites and talk with the people that use them," Hayes says. "They are the eyes and ears of the community. They find out what type of screenings people need most and post information on community bulletin boards."

Other support is provided by a host of advisers from local community centers and health care facilities.

"This project has required a large team effort and collaboration," Plowfield says. "Without our many community partners who help us implement the project, we would not be very effective or efficient in our work."

The grant for the Promoting Healthy Lifestyles initiative is set to continue through September 2003, but organizers say the effects of the program will be far-reaching. They will expand further into the curriculum through other nursing courses and continued outreach via the UD Nursing Center in conjunction with the Department of Nursing.

"We are revising the curriculum to include a community component into most nursing courses," Hayes says.

Plowfield says she hopes that the program will evolve to include more outreach to families, children and adolescents.

"I believe this grant project has paved the way to envision the duality of outreach and scholarship in our educational initiatives," she says.

--Jeanine McGann, AS '93