1. Biggan, Elizabeth A. MSN, RN
  2. Biggan, John R. PhD

Article Content

In community health nursing courses, students are exposed to resources that are available for their patients but rarely have the opportunity to experience what their patient's actual life is like, particularly patients who are part of a vulnerable group. The first author was unable to find a simulation to provide this experience and created a real-world activity for students. In the activity, students are each given a different vulnerable population role for the day. The vulnerable populations include (1) poor and homeless persons, (2) pregnant adolescents, (3) migrant workers and immigrants, (4) individuals with severe mental illness, (5) persons with substance abuse, (6) abused individuals and victims of violence, (7) persons with a communicable disease and those at risk, and (8) persons who are HIV-positive. The scenarios, however, could easily be modified to apply to other populations of interest.


The Activity

The students complete 6 common daily tasks typically done on a regular or semiregular basis (eg, obtaining housing, medications, health care, food, and money and keeping safe). Students cannot use a cell phone or computer to perform their daily activities. In general, the scenario starts with a description of the patient's role (eg, a 23-year-old single parent), a hardship (eg, you were laid off), and a health-related issue (eg, your child needs his immunizations for school). The students are then provided with their list of tasks to complete within 1 week.


The scenarios rely on public transportation, using bicycle for transportation, or walking, and the tasks can be done with a friend. Transportation options may be modified based on the local resources and geography. In addition, the students complete a journal about their experiences.



This activity has now been completed by ~320 students over 4 years. At the end of a recent course, 25 students (84% female) were asked about their experience with the activity. Specifically, students rated how well they understood these populations both before and after the activity, how enjoyable/difficult was the activity, and what they liked/disliked about it. Data collection was approved by the institutional review board of the university.


Using a scale of 1 (low) to 5 (high), students reported that they had a significantly better understanding of at-risk populations after (4.24 +/- 0.60) the activity than before (3.60 +/- 0.76) (t24 = 5.02, P < .001). On average, the students found the activity to be enjoyable (2.92 +/- 1.12) and not too difficult (3.16 +/- 0.99). There were 2 aspects that they liked the most (both 44%): learning about the realities with which at-risk patients live and about available community resources. Students disliked visiting some of the locations (32%), had difficulties with transportation (28%), found the activity time-consuming (16%), and found it difficult to locate some of the places that they needed to visit (8%).


First, some of the locations that the students visited were either unprepared for the students or did not provide much information about the resources at that location. Although many of the locations near the school of nursing were contacted to let them know that students may visit them for this activity, to provide more flexibility, the students were not required to go to a specific location. A number of the students (24%), however, recommended a preapproved list of locations that are aware of the activity and student expectations. We also recommend structuring the times that the students visit these locations based on the activities at each location.


Second, as part of the activity, students were not able to use their own vehicle for transportation. Students disliked having to rely on an alternative means of transportation. In the surveys, 28% of the students recommended allowing future groups to use their own transportation to get to and from each of the locations. Although this would make the task easier, we believe learning about the challenges of using public transportation is important. Third, this assignment requires a considerable amount of time, about 8 hours, which should be considered when designing the course.



In this article, we presented a description of a learning activity that can be incorporated into any nursing community health course. By participating in this activity, the students voiced a broader understanding of the world outside the walls of a hospital and were able to identify community resources available to their patients.