Significance: Poverty is a global issue affecting both the health and quality of life for over 1.2 billion people worldwide.1According to the U.S. Census Bureau, there are 43 million people living in poverty just in the United States.2 Children and the elderly account for nearly one-third of those in poverty, which can have long-term negative outcomes on overall health. Nursing education has been gradually changing to provide better incorporation about socio-environmental aspects of health in their curricula. One aspect in particular that has been important to this growth has been educating students on the relationship between poverty and health. Previous studies have examined students’ knowledge and attitudes towards poverty and have found a lack of knowledge about the circumstances surrounding poverty.3-4
Background: Nursing education using simulation has been shown to expose students to broader experiences then they might receive during their traditional clinical rotation.5 Incorporating simulation is one way that students can be exposed to clinical situations that can help to develop their critical thinking skills, competence and compassion with specific populations. Previous research has explored the use of simulation in various facets of nursing education, which has been found to improve students’ overall knowledge and satisfaction.6 To date, there is little known about the outcomes of poverty simulation specifically, on students’ knowledge and attitudes towards those in poverty.
Objectives: The purpose of this study was to evaluate the effectiveness of a poverty simulation workshop on students’ knowledge and attitudes towards poverty, describe students’ perspectives with the simulation session and identify areas for improvement. The specific aims/research questions for this study were: (1) Are there any significant differences between students’ pre and post evaluation scores following this simulation? (2) what are students’ perspectives about engaging in this simulation and, (3) are there areas in need for improvement for subsequent poverty simulation workshops?
Methods: Using a mixed methods design, a convenience sample of two cohorts of senior undergraduate nursing students participated in a community poverty simulation workshop. The Missouri’s Community Action Poverty Simulation Program7 was used for the simulation. This program was designed to help students understand what it is like to live with a shortage of money and the associated stressors that result. Students were expected to participate as part of program requirements but were asked for consent to have their surveys included in the study. Pre and post-tests and the Attitudes towards Poverty (ATP) short form8 were used to measured students’ knowledge and attitudes about poverty. The pre-and post evaluation survey contains both closed and open ended questions about poverty knowledge and the simulation experience and the ATP short form contains 21-likert scale questions that measures a range of personal attitudes towards people who are poor.
Results: A total of 132 students from two cohorts of students completed the surveys and agreed to participate in the study. There were no significant differences in age, gender or ethnicity between cohorts. The vast majority of students in the sample reported that they had learned something new from this poverty simulation (97%) and that it will impact the way they will interact with patients affected by poverty (94%). The most common items that students marked as ‘do not know’ on both the pre and post tests were related to questions associated with the overall healthcare system, such as, “the social service system in America only has a positive impact on those it serves” and “the private sector has no role in improving the situation of people with low income”. One hundred and fourteen students (86%) reported that they found this simulation to be personally worthwhile. A small percentage of the sample (13%) felt that nursing students should not have to participate in the simulation. Although nearly half of the sample (49%) reported that they would have not attended the simulation if it were not mandatory, the majority perceived it to be positive as reflected in their post test scores and qualitative comments. There were no significant differences on scores from the ATP short form, however several of the items were marked as neutral indicating they had no opinion on the subject either way. Some of these statements include, people are poor due to circumstances beyond their control and society has the responsibility to help poor people were among those having the highest percentages of a neutral response marked.
Implications: The link between poverty and health disparities has been well established. Nurses must be informed about the unique needs of those affected by poverty in order to avoid any misconceptions and stereotypes against this population. Some nursing students lack the age and experience to understand what living in poverty denotes. This should be viewed as an essential component to providing compassionate quality care. It is vital for nursing students/nurses to be able to provide compassionate care for all patients, including those living in poverty. To ensure a competent nursing workforce in an ever-changing global healthcare environment, all nursing students must have a basic understanding about the implications of poverty on health and compassion towards persons living in poverty. It is important to teach nursing students that nursing is a shared responsibility towards the communities we serve and that part of nursing is giving back through volunteering and leadership efforts aimed at serving those who need our care both in our own backyards and across continents.
Impact: This simulation workshop reported in this study is an annual event that is part of our program curriculum. Although in its early stages, its impact can extend beyond participating students, faculty and volunteers towards patients and the communities we serve. The workshop concludes with a keynote speaker invited to come and speak to the students about the needs and concerns about a specific population affected by poverty. Students are then charged with taking action to improve the lives of those in poverty represented in the keynote address. This is accomplished through our college student nurses organization that leads the students’ efforts in fundraising and/or facilitating action to help the group in need. Delivering a message that instills the professional obligation to assist those affected by poverty is the mission of this workshop. Out first year, we focused on a local organization that provides assistance for homeless Veteran’s and then progressed to a statewide coalition focused on providing resources for children of migrant farm workers. Our aim is to further branch our efforts from local towards global impact.
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