IN THEIR SHOES: A COMMUNITY-BASED POVERTY SIMULATION EXERCISE
Rationale/Background: Public health nurses work intimately with issues related to poverty and health; for example, providing referrals and complex case management for low-income clients enrolled in multiple social welfare programs (e.g., Medicaid, Temporary Assistance to Needy Families, food stamps, Section 8 housing). Concerned that traditional lecture-style teaching methods alone were not helping undergraduate students understand the social determinants of health, social justice, and challenges faced by underserved populations in accessing health and social services, didactic and practicum faculty worked together to develop a poverty simulation exercise.
Approach/Methods/Process Used: We developed scenarios—based off of our own clinical experience— of clients in need of community resources (e.g., low income family in need of healthy food, adolescent mother who was abused by parent and kicked out of house after becoming pregnant, elderly woman who is legally blind and living in a rural area). We first introduce students to concepts related to poverty, income inequality and health, social mobility, and critical social theory during a three-hour interactive didactic session. The next day, practicum groups are assigned one of six scenarios and use public transportation to travel to agencies and collect information (e.g., flyers, application forms) about how to access these resources. The next week, students return to their didactic class and reflect on the experience, including the potential for the clients in their scenarios to achieve social mobility.
Outcomes Achieved: We have conducted In Their Shoes for three semesters, and the activity has received positive feedback from students each semester. They express surprise at the number of community resources, frustration by the various challenges encountered in accessing these resources (particularly how time-consuming it is to use public transportation), and dedication to being more aware and compassionate advocates for underserved clients. As one student reflected, “By the end of this activity, I was so frustrated because I felt like I accomplished nothing and in reality I didn't if this was my actual situation. This individual would have lost their income for the day and would have struggled to feed their family. I was able to have an insight of what this population feels on an everyday basis. It helped me gain a new perspective and respect for the underserved population."
Conclusions: Our collaboration for the In Their Shoes was recognized by our school with the Innovations in Teaching Award. We will continue to refine, implement, and evaluate it in future semesters. Future directions include a quantitative evaluation of the exercise using pre- and post-test questionnaires and organizing materials collected by students each semester into a “resource book” that can be used by nursing students throughout their program to increase awareness of community resources to which they can refer clients.