POVERTY SIMULATION IMPROVES UNDERSTANDING OF ACCESS BARRIERS FOR THE IMPOVERISHED

 

Purpose:Our purposes were (1) to sensitize nursing students to the influence of socioeconomic status on healthcare access and the barriers and frustrations impoverished people experience, (2) encourage students’ commitment to reducing these barriers, and (3) prepare students to advocate for people who are impoverished.

Background: As a nation, 6 million more people are living in poverty now than in 2004. Poverty is the single largest contributor to poor health. As poverty becomes more severe, health outcomes worsen.  Many diseases are more common and progress faster among poor people regardless of age. 

Brief Description of Project: During the 3.5-hour simulation, students are assigned identities as members of diversely configured low-income families.  Students develop strategies to meet their family’s basic needs, including food, shelter, living expenses, school, employment, and healthcare.  Activities occur in the face of realistic life challenges, including emergencies, illnesses, and job loss. Faculty volunteer to staff simulated community sites where students interact to attempt to meet their family’s needs. Sites include grocery stores, banks, employment and social services, schools, police stations, childcare, and healthcare facilities. Facilitators debrief students after the simulation. Students respond to an empathy tool pre- and post-simulation and write a reflective paper.

Outcomes Achieved: At the debriefing sessions and in reflective papers, students report increased understanding of the challenges and frustrations impoverished people experience as they attempt to access social programs and other resources. Students express surprise by how quickly priorities change and healthy behaviors decline when faced with poverty.  After the simulation, many students identify experiencing a lack of time necessary to accomplish the tasks required for daily living and report feeling that poor people work much harder than simulation participants had previously thought. To help improve healthcare access, students assert they will educate families about social services, target resources to those with greatest needs, and initiate community and legislative discussion about how poverty affects child and family health. Additionally, they suggest resources should be more user friendly and commit to help make resources available at convenient locations and times. Students’ empathy scores increase significantly from pre- to post-simulation (t = 2.4, p = .02).

Conclusions: Simulation has extraordinary influence on nursing students in helping them understand health disparities, access barriers, and social determinants of health.  Poverty simulations serve to enlighten students about the plight of impoverished people and motivate them to become involved with efforts to reduce poverty, the related health disparities, and barriers to healthcare for this vulnerable population. We recommend poverty simulation be used in nursing school curriculums.