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Purpose: The goal of this experience was to evaluate the impact of a poverty simulation on undergraduate public health nursing (PHN) students’ attitudes towards those living in poverty. Poverty is the most influential social determinant of health. Since nurses care for people from all socioeconomic groups, they will encounter people living in poverty who feel that health care providers are frequently insensitive to their needs and concerns. Therefore, it is incumbent upon nursing faculty to address poverty-related-to-health issues with their students.
Description: Faculty designed a two cohort: simulation vs. control design to ascertain whether or not the poverty simulation positively changes students’ attitudes towards people living in poverty. All PHN students completed the Attitudes Toward Poverty (ATP) scale (Atherton & Gemmel, 1993) at the beginning and end of the quarter. This 37 item Likert scale has a Cronbach’s alpha for reliability of .93 and .89 for validity. Part way through the term, the experimental group took part in a poverty simulation as part of their clinical experience. The simulation was conducted within a school of nursing’s conference rooms and classrooms. Faculty, school of nursing staff, and family members of faculty supervised the various stations. Student groups comprised of three or four were preassigned to a “family”. The simulation began with a briefing and covered a month in the life of a family with 40 minutes allotted for each week. Experiences included those that a family living in poverty is likely to have, such as: taking public transportation; paying bills; dealing with daily needs (groceries and school crises); filing out annual paperwork for various agencies; attending health care appointments; and interacting with police. At the end of the term, all students (experimental and control) again completed the ATP scale.
Findings: The results of the two-way repeated measures ANOVA demonstrated a positive trend in changes in students’ attitudes over time (pretest/posttest) towards people living in poverty for both groups. There was no statistically significant interaction of group between experimental vs. control. Hence, whether or not students participated in the simulation did not significantly alter their attitudes towards those living in poverty. Debriefings with students illuminated the following themes: 1) receiving government assistance is harder than people think; 2) poverty isn’t about being lazy; 3) poverty creates a snowball effect in the family; 4) poor families are stereotyped, stigmatized and marginalized; and 5) good people may be driven by circumstances to do bad or desperate things. Based upon student feedback, the simulation was successful in sensitizing PHN students to the experiences of people living in poverty.
Implications: Our results are inconsistent with other findings using the ATP. However, published findings using the ATP include those using a modified short form, rather than the 37 item form. This prompts the following questions: Was the tool applicable to today’s students’ attitudes? Was there an issue with the simulation’s design? The next step is to keep the simulation the same, but to test the ATD Short Form with 21 items and a reliability of .87 (alpha coefficient) (Yun & Weaver, 2010).