Health care simulation programs usually teach skills — how to perform a procedure or how to treat a condition. However, a recent simulation training in the College of Nursing at the University of Tennessee Health Science Center had less tangible, but equally as important goals.
Seventy-four students participated in a daylong educational program titled, “A Simulation of Living in Poverty,” designed to give them the knowledge to better provide health care services to those facing financial hardship.
The students were assigned scripted roles to simulate situations that those living in poverty face. As part of family groups, they had to budget for and take care of basic needs, including food, housing, health care, travel, education, and more, all within the limited resources assigned. How they and their families fared depended on the choices they made.
“What we’re trying to do is show them that life is very random,” said Marion Donohoe, DNP, APRN, CPNCP-PC, assistant professor in the College of Nursing, who directed the simulation. “We can’t judge people because they don’t have the same resources that we have.”
This was the second year Dr. Donohoe presented the training at UTHSC. It is offered to students twice a term. Originally designed for community nonprofits to help staff understand the populations they serve, the training translates well to helping students expand their worldview.
At this simulation, the participants were mainly BSN students, plus a few third-year medical students, pharmacy students, and occupational therapy students.
“A lot of our students have limited life experiences. The majority of them, over 80 percent, have not lived on their own before, they have been depending on someone else for their food, clothing, and shelter, so they aren’t experienced in knowing what other people face,” Dr. Donohoe said. “Hopefully, this makes them more compassionate and more experienced.”
Armed with this knowledge, they can begin to ask the questions that will make them better providers, she said. This could include asking patients at discharge if they are able to get the medications prescribed for them, or if they have transportation for future appointments. And beyond asking these questions, they will seek out agencies and resources to help their patients.
“I know what it’s like not to have a choice in health care,” she said. “I’ve provided care for families who could not get the resources to help their children. A lot of it was based around the fact that I was in a health care system that didn’t know what the resources were. And once I learned that all I had to do was go outside the institution and find them, then I could help my families better.”
BSN student Rita Hall said the simulation was more emotionally difficult than she had anticipated. For her scenario, she was an unemployed 19-year-old high school dropout with a 1-year-old dependent and a 25-year-old live-in boyfriend. They survived solely off public assistance and what little income he could provide. When the boyfriend missed one day of work, they never recovered from the financial hardship that resulted. “It was saddening, stressful, and frustrating to know that we were about to be evicted from our home, and there was little we could do about it,” she said. “Though I knew it was a simulation, the emotions I felt were very real. I was emotional due to the realization that this was someone’s reality.”
Hall said she believes the experience emphasized the importance of understanding the daily struggles of individuals who are less fortunate. “Developing a better understanding of their circumstances will hopefully keep our biases at a minimum,” she said. “Also, it will enable us to display compassion and empathy when encountering individuals whose situations mirror the scenarios from the poverty simulation. With this change in mindset, we will be more effective in our quest to assist and improve their circumstances.”
That is exactly the point of the exercise. “A lot of the students come away with more understanding of the social determinants of health, which are education, employment, environment, food insecurity, access to care, and access to resources that affect health,” Dr. Donohoe said.