Lessons Learned from Poverty Simulation – “I Will Help Those in Poverty. I Will Make a Difference One Day.”

NMC guest blogger and assistant nursing professor Kiley Petersmith, MSN, RN, describes an action-packed, thought-provoking classroom experience that helped make poverty real for students in the Community-Based Care Across the Lifespan course.

Poverty impacts more than 40 million people in the United States, including thousands of people right here in our own local communities.

For those fortunate enough never to have been poor, poverty may seem like a simple concept: a shortage of dollars. The reality is more complicated with far-reaching implications, especially for future healthcare professionals.

“Everyone deserves equal, quality healthcare and opportunities,” said an NMC nursing student after participating in the Poverty Simulation.

“I will help those in poverty,” another student said. “I will make a difference one day.”

NMC students learn the hard, evidence-based realities that those who live in poverty are also likely to suffer from:

• hunger and food insecurity
• housing insecurity
• increased incidences of disease, depression, addiction and disabilities
• disempowerment and marginalization
• poorer access to and quality of medical care
• shorter lifespans
• stereotyping and prejudice

How do we teach the importance of advocating to advance the health of all humanity, including those living in poverty? One way is by using a Poverty Simulation toolkit developed by the Missouri Association for Community Action.

This is not a game, but an opportunity to role-play a typical month in the life of low-income family members. These are real-life stories and real-life challenges: Putting food on the table. Paying rent. Keeping utilities on. Getting transportation to work or school. Finding childcare. Getting a job. Sometimes losing a job. Chronic illness. Stress. Worry. Injury. Unexpected expenses.

The simulated “community” was a large NMC classroom with participants’ “homes” in the center. “Community services,” such as banks, social services, schools, churches and grocery stores lined the perimeter of the room.

The goal of the simulation is to sensitize participants to the day-to-day realities faced by people who live in low-income situations and motivate change for the populations of poverty in our communities.

This is just one way NMC’s faculty and staff help our students grow as educated citizens and change agents with holistic mindsets. We hope to instill knowledge and skills, so students can utilize their passion to dismantle oppression and promote the health of populations.

This simulation makes poverty feel more real and understandable. The experience educates students on risk factors and early manifestations of poverty, so in clinical practice they can refer individuals to supportive resources to prevent further disparity.

We surveyed students on their mindset before and after the simulation. Their comments after the simulation centered around the eye-opening nature of the experience with common themes of education and advocacy for future patient populations.

Here is a sampling of the students’ insights:

"I’ve realized how important my role will be as a nurse to advocate and educate my patients in poverty and guiding them to the right resources to better their overall health and life."

"I truly feel that out of my clinical simulations, this one has taught me the most. I had to put myself in the shoes of someone in poverty and try to ‘make it.’ I only played a 10-year-old, but I could feel the stress of the ‘parents’ in my ‘family.’"

"‘Poor people do not value education.’ ‘Poor people are lazy.’ ‘Poor people are substance abusers.’ These are just a few assumptions that I had prior to the simulation, and I'm sure several other students have had as well. However, my assumptions have completely changed from these after the simulation."

"This simulation definitely changed how I will practice as a healthcare professional because I really want to learn about the different resources available in our city for lower income families and families who live in poverty here. I want to be able to know about these places, so that I can help point future patients of mine in their direction to hopefully get them the help they need that will help take some of the burden off their shoulders."

"As a nurse, it is my job to treat, educate and advocate for patients. This simulation has taught me to do so without assumptions and judgments. It’s also taught me to do so with patience and understanding. I will help those in poverty. I will make a difference one day."

"This Poverty Simulation experience helped me to realize the frustrations that people living in poverty may have on a daily basis. This simulation is the perfect hands-on activity to tie together all the information that was talked about and help students to realize the major impact this has on people’s lives daily. This is going to help me be more aware and competent in my care."

"As a future nurse, it is important to never judge somebody based on how they look, their level of education or how much money they make. Everyone deserves equal quality healthcare and opportunities. It’s our duty to be knowledgeable, well-rounded nurses who help others in every way possible. I thought this simulation was an amazing educational experience unlike anything we’ve done before at NMC."

"This simulation has opened my eyes to how vulnerable these people are and how I, as the nurse, need to act as their advocate to give my patients the best possible care. I will not have any judgment towards my patients in poverty, and I will let go of any stigmas that come with being low-income or in poverty."

No better time exists to be leaders in promoting inclusion, understanding, awareness and health for vulnerable populations. At NMC, we are doing our part to teach the next generation of healthcare providers how to recognize disparity, the implications on health and create solutions for vulnerable individuals.

This classroom experience is only the beginning of our use of the Poverty Simulation to create awareness of diversity, social injustice and the stigmas members of our communities face every day.

Editor's Note: The photos were taken from the poverty simulation done this spring semester in the Community-Based Care Across the Lifespan course.