It is imperative that nurses are equipped to meet the challenges of working with vulnerable populations, including the poor. Given the strong correlation between poverty and poor health worldwide (WHO, 2014), nurses must be prepared to work with the poor at some time during their career. A lack of understanding, as well as negative perceptions by healthcare providers of those living in poverty may have a damaging effect on access to and quality of care (Noone, Sideras, Gubrud-Howe, Voss, & Matthews, 2012). Therefore, it is the responsibility of nurse education programs to provide learning activities that encourage students’ cognitive and affective development of knowledge and attitudes that are required to provide comprehensive, empathetic, nonjudgmental, and accessible nursing care (Reid & Evanson, 2016).
This project piloted the Community Action Poverty Simulation (CAPS, Missouri Association for Community Action, n.d.) with entry level baccalaureate degree candidate nurse students (N = 43). Participation in a simulated poverty experience was designed to foster students’ appreciation for the circumstances and challenges faced by those living in poverty (Clarke, Sedlacek, & Watson, 2016). Assessment measured the extent to which participation in the poverty simulation changed the students’ understanding and attitudes toward people living in poverty.
Methods:
CAPS was developed as a tool to encourage communities to think about the harsh realities of poverty and to motivate actions to make changes (Missouri Association for Community Action, n.d.). Within this simulation each student was assigned an identity as a low-income family member and required to navigate life for a simulated month. A convenience sample of 43 nursing students participated in three hours of simulation activities. Students completed pre- and post- simulation surveys using the Attitude Toward Poverty Scale Short Form (ATP, Yun & Weaver, 2010). Paired samples t-tests compared changes in students’ attitudes overall and by item.
Results:
Participants in this study were 93% women and 74% were White, similar to the demographics of nurse students in the U.S. (AACN, 2014). Most (67%) were in their third year of a four-year baccalaureate nursing program, and a majority professed no political affiliation (58%). T-test comparisons of ATP scores before and after the poverty simulation revealed significant differences on the overall scores (t (43) = -2.63, p = .023), as well as on several of the individual items. The differences indicated that following participation in the poverty simulation nurse students demonstrated more acceptance and less negative judgement towards people living in poverty.
Conclusion:
This pilot demonstrated that CAPS, a short-term intensive poverty simulation, may effect changes in nursing students’ attitudes toward people living in poverty, an essential component of comprehensive, empathetic, nonjudgmental, and accessible nursing care. These results confirmed a study by Yang, Woomer, Agbemenu and Williams (2014), who also found nursing students benefited from a simulated poverty experience. This educational strategy should be replicated with a larger sample of nursing student participants to fully assess the CAPS experience as an effective strategy for teaching the lived experiences of poverty and impacting preconceived notions about this vulnerable population. Further research could include participation of other social and health professions students, as sensitization to the challenges of poverty are important for all caregivers. It is important to enhance the cognitive and affective development of nursing students to improve their understanding of poverty and its effects (Reid & Evanson, 2016) and this pilot suggests that CAPS can facilitate the requisite learning and development.