Evaluating a Nursing Program's Effect on Perceived Understanding of Living in Poverty

Monday, 30 October 2017

Christine R. Hammond, MSN
Research College of Nursing, Kansas City, MO 64132, MO, USA
Nicole Kreimer, MSN
Research College of Nursing, Kansas City, MO, USA

Background/Literature review:

The link between health and poverty is well-documented. Although poverty is a social determinant of health those who live in poverty often express that service providers are insensitive to their needs and concerns (Bullock, 1995). Disparities in life-expectancy have been found to be linked to county poverty level, educational attainment, and racial compositions (Davids, Hutchins, Jones & Hood, 2013). These researchers found that life-expectancy was negatively correlated with percentage of residents living below the federal poverty level. Because of this link between poverty and health, it is critical that health care workers understand the experience of living in poverty. While it has been shown that nursing students’ have more positive attitudes toward those in poverty than the general public, there is still a documented need to inform students about the structural factors that lead to poverty (Reutter, Sword, Meagher-Stewart, & Rideout, 2004). Many nursing schools have used poverty simulations, both on-ground and virtually, to teach students about poverty (Noone, Sideras, Gubrud-Howe, Voss, & Matthews, 2012; Patterson & Hulton, 2012; Menzel, Willson, & Doolen, 2014; Yang, Woomer, Agbemenu, & Williams, 2014).

Purpose of the study:

Like other nursing schools, the poverty simulation was found to be effective at increasing nursing students perceived understanding of five aspects of living in poverty for 4 cohorts of students at the institution in this study. The poverty simulation is a teaching strategy currently used in the last semester of this baccalaureate nursing program. The purpose of this ongoing study is to evaluate the effect of this baccalaureate nursing program, whose mission includes social justice education, on nursing students’ perceived understanding of the of the same five aspects of living in poverty. Given the increase in perceived understanding following the poverty simulation this teaching strategy may be better utilized at the beginning of the nursing program.


A total of 169 students (4 cohorts) have experienced the poverty simulation as a part of their Community Health Nursing clinical course at the end of the program. The students took a self-report survey that asked them to rate understanding of five different aspects of living in poverty. The five aspects are: 1) the financial pressures faced by low-income families in meeting basic needs, 2) the difficult choices people with few resources need to make each month when stretching a limited income, 3) the difficulties in improving one’s situation and becoming self-sufficient on a limited income, 4) the emotional stresses and frustrations created by having limited resources, and 5) the positive and negative impact of the social service system on people with limited resources. They then took the same survey after experiencing the high-fidelity poverty simulation.

A current group of 48 students will complete the program in August 2018. They will experience the same simulation as a part of their program. This group of students, however, were surveyed prior to starting the program in orientation, after their first term experiencing the social justice and clinical experiences. They will be surveyed again after their second term and then after the poverty simulation.


The survey is a self-report understanding of the aspects of poverty. Students may perceive that they should report that they have higher levels of understanding because they perceive this as socially acceptable. Long-term effect in perceived understanding has not been studied.

Findings and Implications for Nursing Education:

There was a statistically significant increase in perceived understanding of each aspect of living in poverty after the simulation experiences (p= < 0.01). Given the repeated reported increases in understanding of the five aspects of living in poverty, poverty simulation is recommended for populations of students who have little experience with those aspects of living in poverty. For the current groups of 48 student’s data collection is not complete. Data analysis will be completed to evaluate the impact on perceived understanding of the five aspects at key points throughout the nursing program. Recommendations will be developed based on this analysis.