Abstract
Abundant evidence supports the benefits of simulated learning. Simulations enhance students ‘communication and teamwork skills and expose students to situations they may not experience in clinical rotations. More specifically, research has confirmed the benefit of conducting poverty simulations with nursing and social work students from financially privileged backgrounds; these students demonstrated an enhanced structural understanding of poverty over a behavioral understanding, following simulated experiences (Noone, Sideras, Gubrud-Howe, Voss, & Mathews, 2012). This article describes the process of planning and implementing a poverty simulation.
The World Health Organization (2018) and the United States Department of Health and Human Services (2020) define social determinants of health as the social and economic conditions, such as education, income, and social support, that influence the differences in individual and group health outcomes. Socioeconomic status is one of the most powerful determinants of health (Khullar & Choski, 2018; Reid & Evanson, 2016), an alarming statistic considering that 11.8% of the U.S. population have a pre-tax income below the poverty threshold applicable to their family size; that is, they live in poverty (Semega et al., 2019). It is imperative that educators facilitate experiences to help future health-care professionals understand the relationship between poverty and health (National Academies of Sciences, Engineering and Medicine, 2016; Thornton & Persaud, 2018), especially since students who come from various socioeconomic and cultural backgrounds may find it challenging to comprehend the structural, political, and societal factors related to these two variables. This article presents a guide to implementing a collaborative, interprofessional student- and faculty-led poverty simulation in an academic setting that can be a useful tool for faculty looking to utilize this type of learning strategy to enhance students ‘understanding of poverty.
Planning Stages
Initial Planning
Faculty members may directly contact students whom they recognize to be potential facilitators for the simulation. All team members should discuss the poverty simulation objectives and the general timeline for planning and implementation, and agree on a target group of participants. The team may consist of students from various fields of study, but they must collaborate early in the process with the faculty of these departments to identify clear objectives, with the aim of strengthening participants ‘education. Consider project concerns such as technical challenges and ethical issues. Considerations may include the simulation setting, attrition rate for voluntary academic activities, and the limitations of the poverty simulation to demonstrate the complexity of poverty.
Interprofessional Collaboration among Departments
Interprofessional department leaders need to receive information on the purpose, objectives, and requirements of the simulation. Additionally, discussing the information face-to-face to answer clarifying questions and to explain the importance of interprofessional collaboration in the participants ‘baccalaureate education is vital. Team members could email faculty
It is imperative that educators facilitate experiences to help future health care professionals understand the relationship between poverty and health, especially since students from various socioeconomic and cultural backgrounds may find it challenging to comprehend the structural, political, and societal factors related to these two variables.
Study of the Literature
A literature review will help the team gain insight into how other groups have implemented poverty simulations. The team members can divide this task and share their findings in an online table listing the overall purpose, target audience, objectives, challenges, and recommendations for each simulation.
Selection and Development of Relevant Tools
Simulation Curriculum. Find a poverty simulation curriculum that fits the team's objectives and satisfies its ethical concerns. Note that some premade simulations may recommend the participation of low-income volunteers or community resource agency staff to play the role of business owners or agency leaders in the simulation. As an alternative, team members may design their own poverty simulation with careful consideration of intellectual property rights and avoiding plagiarism.
Socioeconomic Index. Collecting information on study participants ‘exposure to poverty can enable team members to better prepare for emotional responses. Faculty in departments with greater expertise in assessing socioeconomic status, such as those in the sociology, anthropology, economics, or social work departments, can help create an index based on relevant indicators including house ownership, socioeconomic class, history of government assistance, and history of working before the age of 18 to contribute to family income.
Emotional Response Plan. “Real-life” family scenarios in the poverty simulation (e.g., having a parent go to jail, eviction, shooting) may be emotionally triggering to some participants. A plan for handling emotional responses could list events that have the potential to elicit an emotional response, the emotional responses that can occur, and the resources available to participants during and after the simulation. Resources may include college counseling center staff, clergy, and social work faculty. If available, they should be in a separate room to provide privacy to participants requesting help.
Educational Tools. Team members may develop quizzes or infographics with up-to-date information on local poverty statistics to provide to participants while they are simulating being at work or at school. This information may include unemployment rates and access to food, overall poverty rates, and eligibility criteria for government assistance. Information needs to come from reliable sources such as the U.S. Census Bureau and the State Department of Health.
Debriefing Plan. Team members should evaluate the debriefing plan provided in the chosen simulation curriculum to determine whether it fits their ethical concerns and objectives. If not, the team may choose to design their own debriefing plan that includes rules of engagement and debriefing questions for small and large groups.
Timeline, Participant Selection, and Logistics
Scheduling a date for an interprofessional simulation to fit the needs of students in varying majors can be difficult. The departments should collaborate early in the process to choose a day for the simulation. To ensure student participation, team members may designate the simulation as a course requirement. To increase the study participation rate, team members should inform students of the simulation date with sufficient advance notice. Participants may receive an information sheet that describes the simulation purpose and participants ‘roles, and clarifies whether participation is voluntary. This sheet may be shared via email or in printed form at least 2 weeks before the simulation. Team members may make classroom visits to reinforce this information to students.
The team members should thoroughly review the poverty simulation curriculum, including participants ‘roles and the ground rules, and study the floor plan of the available space to determine whether the curriculum needs to be adapted to fit their resources. They may develop a simulation day schedule including specific times for volunteer and student participant orientation, simulation implementation, and debriefing. A break between the end of simulation and the debriefing allows participants to process their thoughts and emotions, to more freely express them in a group setting.
Collaboration with Community Resource Agencies
If the simulation curriculum chosen recommends the participation of low-income volunteers, team members may reach out to local community resource agencies to discuss the poverty simulation, its goals and expectations, and ethical ways of involving their clients in this activity.
Contact community resource agencies at least 6 months in advance to have time to build a trusting relationship. The main concern of agencies is not to abuse the relationships with their clients and to protect their clients ‘right to privacy. To facilitate this process, team members may meet with community resource leaders multiple times to clarify that the rationale behind involving their clients in the simulation is to empower them to share their experiences (if they wish) in a safe environment, to help future health professionals understand the connection between poverty and health. Community resource clients have limited time and resources; to show awareness and respect for that, the plan may include a small stipend for these volunteers.
Team members may also choose to involve community resource staff members themselves as volunteers, because of their extensive knowledge of the complexity of poverty.
Ethical Implications
Team members must consider the ethical implications of a simulation that uses family roles based on “real-life” situations. It is important that participants understand that the poverty simulation is not a game.
Simulation Day
Orientation
On the simulation day, team members act as facilitators to ensure that the simulation runs smoothly. First, they orient community volunteers to the space, provide information folders, and answer their questions.
Next, as student participants arrive, they are randomly assigned to families, but with students from different majors in the same family to promote interprofessional collaboration. Once orientation ends and the simulation begins, the team members can answer clarifying questions and monitor for emotional responses.
Description of the Simulation
In an exercise typically lasting 2–4 hours, every few minutes of real time equals a simulated week; participants experience living in poverty as members of a family. Together they have to fulfill daily activities such as going to school and/or work, paying rent or mortgage, buying food, and applying for financial assistance. They may also experience a series of challenges such as eviction, loss of job, theft, and healthcare emergencies.
Implementation of the Emotional Response Plan and Debriefing Plan
The team may choose to designate one or two members to be in charge of monitoring emotional responses and the efficient implementation of the emotional response plan. Such planning may include assisting the participant to leave the simulation room and connect with resources immediately and on the days to follow. Team members may need to be flexible during the debriefing and allow for unexpected occurrences such as running out of time, lack of participation, and volunteers wanting to contribute to the debriefing.
Key Points
To strengthen the participants ‘understanding of poverty as it relates to their fields of study, it is important to consider what specific aspects of the simulation represent an opportunity to provide education. For example, the time participants spend simulating being at work or at school could be used to share info-graphics or quizzes with relevant data. To promote interprofessional collaboration among students, team members may provide scope of practice statements about each of the professions participating in the simulation. Clarity of expectations and responsibilities for
Conducting interprofessional poverty simulations furthers the evidence on effective and ethical strategies to address this content at education institutions.
Conclusion
Conducting interprofessional poverty simulations furthers the evidence on effective and ethical strategies to address this content at education institutions. By sharing the process and lessons learned, this article may assist educators looking to implement a similar simulation in their programs.
Footnotes
Genesis Fukunaga Luna Victoria, BAN, RN, (she/her), is a registered nurse who is passionate about nursing education and nursing research. She is a member of Sigma Theta Tau International and of AWHONN. She collaborated with a team to implement a poverty simulation and research its impact on students ‘understanding of poverty and health.
Mary Beth Kuehn, EdD, RN, PHN, (she/her), is an associate professor of Nursing at St. Olaf College in North-field, Minnesota. Her research interests include public health; specifically the social determinants of health. She facilitated the faculty-student research team to implement a poverty simulation and study its impact on students ‘understanding of poverty and health.
Disclosure. The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.
Funding. The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.