Using simulation to help beginning nursing students learn about the experience of poverty: A descriptive study

Background: Increased numbers of individuals and families in the United States are living below the poverty level. Beginning nursing students must start to develop an understanding of the constraints of living in poverty and its relationship with health. Objectives: To describe the effects of a poverty simulation implemented in a freshman-level course as a beginning preparation for working with patients who face financial hardship. Design: Descriptive study with a pre-test and post-test design. Setting: School of Nursing within a private, religiously-affiliated university in the northeastern United States. Participants: 170 freshman-level Bachelor of Science in Nursing (BSN) students. Methods: Students participated in a poverty simulation designed to sensitize participants to the experience and realities of living in a typical low-income family. Using the Undergraduate Perceptions of Poverty Tracking Survey, data were collected on students' general attitudes toward poverty, empathy for those living in poverty, and commitment to addressing poverty, two weeks prior to and one week after the poverty simulation experience. Results: A significant decrease was noted in total scores from pre-simulation to post-simulation with a mean decrease of 7.9 +/- 10.1 points (+/- standard deviation), p < .001. Significant decreases were also noted in four of the six subscales, including the Welfare Attitudes, Poor are Different, Equal Opportunity and Lack of Resources subscales, ps < .001. Changes represent improvements in the students' attitudes toward poverty, empathy for those faced with poverty, and recognition of societal and structural barriers encountered by individuals living in poverty. Conclusions: This poverty simulation contributed to building empathy among freshman, BSN students and preparing them, early on, to provide more sensitive care to economically-disadvantaged populations. Nursing programs should include similar learning experiences at the beginning of curricula, so that this knowledge becomes an integral part of the care students provide throughout their clinical experiences.