Simulating Poverty and Building Understanding

Understanding social justice, reserving judgment about others and learning about personal biases are important lessons for nursing students, but UNC Professor of Nursing Faye Hummel points out that these lessons aren't always easy to bring to the classroom. That's one reason why each semester, Hummel and her colleagues set up a poverty simulation for nursing students.

The simulation kit, developed by the Missouri Community Action Network, helps give participants a sense of how it feels to live in poverty.

"It really brings the notion of equity and social justice to someone's inner soul. You may dismiss it when you're in a classroom and someone's just talking about it, but it's much more difficult when you're immersed in the situation, having the frustrations and the stresses associated with not getting by that it brings that whole concept of poverty and disparity and inequity to life," Hummel says.

Held in the University Center Ballrooms, the simulation includes nearly 80 nursing students who are assigned a role within their simulated family. Twenty faculty and staff members act as employers, bankers, pawnshop owners, and service providers. Katrina Einhellig, an assistant professor of nursing, plays the role of a drug dealer, while UNC police officer Larry Raimer brings law enforcement to the imaginary community.

Families start in groups at the center of the room, with service providers on the periphery. Each simulated week lasts 15 minutes, with a five-minute weekend; there are four weeks and three weekends during the simulation.

Employed participants spend seven minutes of their 15-minute week at work. The remaining eight minutes of the week are spent getting groceries, finding resources, buying transportation passes or arranging for childcare. Families range from single parents with infants to elderly grandparents. Participants spend weekends making plans and strategies.

As the simulation begins, the mood is calm, and students are orderly and optimistic. By the third simulated week, when a whistle blows to signal the week's start, participants run to be first in line for employment or services. A few families face mortgage foreclosures.

Senior nursing student Mandy Alvarez -- who played the role of a 38-year-old mom -- was surprised by the simulation's intensity. She started the second week with no groceries, and no time spent with her teenage daughter or husband.

"At the beginning," Alvarez says of fellow nursing students who made up her family, "we thought we had a plan for how we were going to navigate through the month. But as it went on, we just lost control a bit."

Although no one in her simulated family was truly going hungry, the experience still felt real, according to Alvarez.

"To not ever feel particularly successful was the most powerful part for me," she says. "I have a better appreciation for the constant, negative walls always rising to meet you."

Hummel thinks that Alvarez's experience reflected the stress that many of the students felt. "Many say they're very happy it was only a simulation," she says.

It's an experience UNC nursing graduates are able to apply during their work in healthcare.

"They've come back saying that when they've been dealing with patients who are poor, they recognize that poverty sometimes is really beyond an individual," Hummel says.

As students debrief at the end of the simulation, they take with them a changed perspective.

"I've heard people say they were still affected by it long after we were done," Alvarez says. "We've all talked about how it took us a couple of days to come down from the experience. In class we talk about health disparities, and the kinds of challenges that families might be facing, but the simulation really made people feel it."