Experiencing Poverty Together: Fostering Empathy Through an Experiential Community Action Poverty Simulation

To provide holistic care that addresses all aspects of patient needs, nurses must understand the complexities of healthcare for the large population of people who live in poverty. The World Health Organization (WHO) recognizes the Social Determinants of Health (SDOH) as individual income, living conditions, social supports, and access to adequate food sources, education, and healthcare. Eighty percent of a person’s ability to attain health and well-being is related to the SDOH. In the United States, Healthy People 2030 and accrediting bodies for professional nursing programs focus on the SDOH and the impact of these determinants on health equity and access to care. Thus, as nursing students learn about challenges faced by persons who live in poverty conditions, it can be beneficial to also experience what their everyday life entails. One option available is the use of poverty simulation tools. This article provides an overview of the Missouri Community Action Network Community Action Poverty Simulation (CAPS) used in a Bachelor of Science in Nursing (BSN) curriculum to enhance student understanding about the experiences of living in poverty, to increase their ability to analyze the relationship between the SDOH and poor health outcomes, and to identify potential personal attitudes and biases. We offer information about our experiences with poverty simulation planning, implementation, and evaluation.

Background: Social determinants of health (SDoH) encompass the conditions in which people are born, live, learn, work, play, worship, and age. These factors are particularly relevant in obstetrics and gynecology, where health disparities are linked to worse outcomes for disadvantaged populations. Non-Hispanic Black patients, for example, are three times more likely to die from pregnancy-related complications compared to White patients. While online platforms have proven effective in enhancing healthcare education by offering flexible learning schedules, there is a notable lack of e-learning platforms specifically designed to improve knowledge and clinical reasoning regarding health disparities in the OBGYN setting. To address this gap, we developed a free e-learning platform integrating social determinants of health into clinical reasoning. This study aimed to assess the impact of our platform on increasing awareness and understanding of SDoH and their role in healthcare disparities through pre- and post-test case assessments. Methods: A repository of virtual case simulations targeting Obstetrics and Gynecology foundational knowledge, incorporating social determinants of health, was developed by a multidisciplinary team from the Louisiana State University Health Sciences Center-Shreveport (LSU-HS), including the School of Medicine (Department of Obstetrics and Gynecology) and the School of Allied Health Professions, as well as the Louisiana State University-Shreveport (LSU-S) Department of Computer Sciences. Physician assistant and physical therapy students from LSUHS – School of Allied Health Professions, who had completed or were completing their women’s health clinical rotation, were included. Thirty students were recruited via email and campus instructors; however, three did not complete the modules, and one had incomplete pre/post-tests. Participants accessed the e-learning platform via their student email. Surveys administered before and after completing ten virtual case modules assessed students’ comfort and competency regarding SDoH in OBGYN. The surveys included 25 questions across four categories: perceived importance of SDoH in healthcare, confidence in understanding and discussing SDoH, confidence in discussing SDoH with patients, and perceived impact of SDoH on clinical outcomes and decision-making. The post-test survey also assessed the perceived usefulness and impact of the modules. A Wilcoxon Signed Ranks test was utilized to determine whether subjects’ comfort level with the SDoH in OBGYN had changed. The Wilcoxon Signed Rank test and descriptive statistics were generated using the SPSS Version 29. Results: Pre-survey results indicated that 60% of participants had never heard of SDoH, 63.3% lacked confidence in listing the five SDoH domains, and nearly 65% had never received formal training on SDoH. Most participants (80%) believed interprofessional teams were better positioned to assess SDoH than single professionals, 60% acknowledged the impact of SDoH on clinicians’ decision-making, and 96.7% recognized the impact on patients’ decision-making. Post-survey results showed that 80% of participants felt the e-learning tool influenced their decision-making perceptions. User-friendliness was rated highly, with 48.1% giving it a 10 out of 10, and approximately 74% found the platform easy to use. Open-ended feedback praised the modules’ accessibility and clarity, though suggestions included a refresher on SDoH before the modules and adding explanations for answers. The Wilcoxon Signed Ranks test analysis indicates that the e-learning platform significantly impacted students’ confidence level in discussing the following domains: living situation and housing stability (p<0.014), food security (p<0.007), personal safety (p<0.025), financial stressors (p<0.002), employment (p<0.008), and education (p<0.014). The e-learning platform significantly increased participants’ confidence in knowing the SDoH (p<0.001), listing the five domains of SDoH (p<0.001), and perception that they had formal training on SDoH (p<0.001). Conclusions: The e-learning platform significantly increased students’ knowledge of SDoH and their confidence in applying it in an OBGYN clinical context. Initially, most participants were unfamiliar with SDoH, but post-module completion showed improved confidence in discussing all five SDoH domains with patients. These findings emphasize the importance of integrating SDoH modules into health professions curricula using e-learning platforms. Future research should involve larger student populations and include pre-health programs such as medical, nursing, and occupational therapy to validate these findings further.

Critical thinking is a crucial skill in the nursing profession and must be fostered through nursing education. Simulation-based learning (SBL) with technological modalities is a pedagogical approach to enhance critical thinking skills for nursing students. The use of technology in SBL to achieve critical thinking skills is diverse. No previous scoping review has systematically mapped studies on SBL supported by technology to enhance critical thinking in nursing students. This scoping review aimed to systematically map research on the use of SBL supported by technology to enhance critical thinking in nursing students. This scoping review was conducted according to the framework by Arksey and O'Malley and was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, Embase, PsycINFO, and Web of Science databases in 2021 and repeated in 2023 and 2024. Pairs of authors independently assessed titles, abstracts, and full-text papers and extracted data from the included studies. The data underwent summative and thematic analysis and were categorized according to the findings. In total, 4 main categories of technology applied in SBL were identified: computer-based simulations, human-patient simulators, virtual reality or immersive virtual reality, and others. The findings revealed a shift across time in the technology used for SBL to enhance critical thinking, from human patient simulators to computer-based simulations. A dominant part of the included studies published after 2018 (21/44, 48%) incorporated a combination of asynchronous and synchronous learning activities. The theoretical foundation of the studies revealed a range of scientific theories and conceptual frameworks and models. Enablers of or barriers to the enhancement of critical thinking skills in nursing students were identified within the following themes: affinity for and availability of technology, realism, accessibility, engagement and motivation, validation, return on investment, and enhanced critical thinking through SBL using technology. There has been a noticeable shift in the technology and use of technology in SBL. Descriptions of the applied technology and pedagogical considerations are pivotal for comparing or synthesizing research results. There has been a trend toward a blended educational approach combining synchronous and asynchronous learning activities. User technological proficiency and the perceived quality of the technology are imperative in the development of critical thinking. Realism, engagement, and motivation play pivotal roles in the enhancement of critical thinking in technologically supported SBL. The establishment of robust theoretical foundations of research and standardized research practices will strengthen the evidence obtained from the research conducted.

Linking critical consciousness and health: The utility of the critical reflection about social determinants of health scale (CR_SDH)

Research suggests that some speech-language pathologists are uncomfortable treating people who stutter. Accessing quality clinical education experiences in stuttering is difficult given the ongoing rise in students enrolled in speech-language pathology programmes and the limited number of stuttering-specific placements available. Simulation-based learning is a viable option for providing speech-language pathology students with practical experience in a safe learning environment. Whilst research has found that simulation-based learning experiences in stuttering assist in the development of students' clinical skills, students' perceptions of participating in stuttering simulation-based learning are yet to be explored. To investigate speech-language pathology students' comfort, anxiety, knowledge and confidence in the management of stuttering at the commencement of an academic stuttering course and before and following participation in a stuttering simulation-based learning programme. This study used a cross-sectional survey design. Participants were 105 undergraduate and graduate entry masters speech-language pathology students enrolled at an Australian university. Students engaged in a stuttering simulation-based learning programme embedded within an existing academic course on the management of stuttering. A purposefully developed survey was administered at three time points: pre-course (T1), pre-simulation (T2) and post-simulation (T3) in order to explore students' comfort and anxiety levels, and perceptions of their knowledge and confidence in stuttering management. Descriptive statistics were used to report the medians and range of students' responses. Changes across all time points and between each of the time points were determined using the Friedman test and the Wilcoxon signed rank test, respectively. Statistically significant differences (p < 0.001) were observed on all matched survey items (n = 96) across all time points. Between each time point, a significant difference in students' perceived knowledge levels was found with small to large effect sizes. However, there was no difference in students' perceived comfort and anxiety levels between the time points of pre-course and pre-simulation. Open-ended responses on the post-simulation survey revealed that students valued learning about stuttering within a simulation-based learning environment. Simulation-based learning experience in stuttering management was valued by students. When accompanied by theoretical content, participation in a stuttering simulation-based learning programme supported students to feel more comfortable and less anxious about working with people who stutter. This finding has implications for the development of clinical skills in the assessment and treatment of adults who stutter. What is already known on this subject Simulation is a teaching approach used within speech-language pathology to support the development of students' clinical skills. Simulation provides a safe learning environment for students, an opportunity for repeated practice and is valued by students. What this paper adds to existing knowledge This study explored students' perceptions of their comfort, anxiety, knowledge and confidence in working with people who stutter before and following participation in a simulation-based learning programme. It describes a stuttering simulation-based learning programme that can be embedded into speech-language pathology programme curricula. What are the potential or actual clinical implications of this work? The stuttering simulation-based learning programme detailed in this study can be applied and embedded in speech-language pathology curricula. It can be used to support the development of students' confidence in the assessment and management of stuttering.

Poverty remains a pressing issue even in the world’s wealthiest nations, and the stigma surrounding poverty represents a critical barrier to reducing it. We examined the effectiveness of an experiential learning intervention in reducing poverty stigma. Undergraduate students participated in a modified version of The Community Action Poverty Simulation (CAPS), an immersive 3-hour experience, in which they were assigned a role as someone living in poverty and then tried to provide basic necessities (food, shelter, etc.) for themselves and their family for a simulated month. Results showed the intervention was largely effective. After the intervention, participants were more aware of structural barriers faced by people living in poverty (made more external attributions), were less likely to blame individuals for poverty (made fewer internal attributions), and reported more positive stereotypes and attitudes towards the poor. Importantly, they were more willing to support poverty-reducing policies, offer resources, and take political action, and these increases in allyship behaviors were largely explained by the changes in attributions and stereotypes. Key words: poverty-based stigma, experiential learning intervention, stereotypes, attributions for poverty, allyship, Community Action Poverty Simulation, economic inequality, meritocracy, social justice, intergroup relations.

The use of simulation-based learning as an educational tool in nursing.

Five nationally representative U.S. federal data sources consistently showed the link between poverty and poor health outcomes. To determine the modality effective in teaching students about poverty and health, this study compared the attitudes toward poverty of students participating in the Community Action Poverty Simulation (CAPS) and the poverty table-top simulation (Dwell™). In this quasi-experimental study, undergraduate and graduate nursing students and physical therapy students participated in either CAPS or a table-top simulation (TTS) depending on their semester of enrollment in the relevant course. The Undergraduate Perception of Poverty Tracking Survey (UPPTS) was administered before and after each simulation. The analysis included 118 matched pairs. Using MANOVA tests, the authors found no group difference in the overall change of attitude after the simulations (p=.232). However, by the subscale analyses, TTS significantly increased students' willingness to help (p=.008, η2 =0.058) and their empathy toward those living in poverty (p=.039, η2 =0.039). TTS participants had more elements of improvement, but both modalities were found to change participants' attitudes.

Interactive Computer Simulation for Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Substance Use in an Undergraduate Nursing Program

Caring for the poor: Lessons learned from a simulation on social determinants of health

Learning From the Past and Working in the Present to Create an Antiracist Future for Academic Medicine.

The NCSBN National Simulation Study: A Longitudinal, Randomized, Controlled Study Replacing Clinical Hours with Simulation in Prelicensure Nursing Education

The study aim was to evaluate the effectiveness of two simulated poverty teaching interventions-the Community Action Poverty Simulation (CAPS) and the Oxfam Hunger Banquet-to improve undergraduate nursing student attitudes toward people living in poverty. Freshman and sophomore nursing students participated in a Missouri Community Action Network CAPS® experience or an Oxfam America Hunger Banquet® during a 3-year period, and completed pre- and post-assessments using the Undergraduate Perceptions of Poverty Tracking Survey (UPPTS). A significant improvement in UPPTS scores was seen in students after participating in a CAPS experience and less of an improvement was noted after participating in a Hunger Banquet. Both simulated poverty teaching interventions had positive effects on the students' perceptions toward people living in poverty, but the CAPS had a greater influence on improving student attitudes. [J Nurs Educ. 2020;59(2):83-87.].

Background: Pharmacists are well-positioned to assist patients facing poverty with financial and well-being resource navigation. Pharmacy educators must find avenues for students that foster awareness of applicable challenges encountered by economically disadvantaged patients. Objective: This study examines the impact of a poverty simulation on pharmacy students' socioeconomic and patient advocacy attitudes and beliefs. Methods: Third year professional pharmacy students participated in the Community Action Poverty Simulation (CAPS). Students were asked to voluntarily complete a survey prior to and following their participation. The survey was based upon a combination of 3 previously validated survey tools: Attitudes Toward Poverty (ATP) scale, Medical Student Attitudes Toward the Underserved (MSATU), and the Locus of Control Scale (LCS). Students also responded to open-ended questions postsimulation. Results: Forty of the 74 students completed both the presimulation and postsimulation surveys. Significant changes were seen in a matched sample analysis for 17 of 49 survey questions. Prominent differences (decreasing agreement) came from the statements: "An able-bodied person collecting welfare is ripping off the system" and "Welfare makes people lazy"; and increasing agreement that "I feel personally responsible for providing medical care to the needy." Open-ended survey responses reflected a greater understanding of time and effort needed to locate and navigate available resources, and challenges such as adhering to medication regimens due to inability to pay. Conclusion: A poverty simulation, such as CAPS, is an effective method to encourage pharmacy students to reflect on their future impact toward patients facing the challenges of poverty. The shift in students' attitudes and beliefs on various measures revealed that the simulation had an impact on altering perceptions for those with low socioeconomic status.

This study aimed to predict the adoption of EBP based on critical thinking levels among nursing students. As future healthcare providers, nursing students must acquire essential skills and competencies to transition into clinical practice effectively. Critical thinking and EBP are two influential components that play a pivotal role in this process. This descriptive-analytical cross-sectional study was conducted on 300 nursing students. Participants were selected using a convenience sampling method. Data collection tools included a demographic information checklist, an EBP questionnaire, and a critical thinking questionnaire. A total of 300 students participated in the study, of whom 51.7% were male. The mean age of participants was 22.41 ± 2.01 years, and their average GPA was 16.39 ± 1.17. The mean scores for EBP adoption and critical thinking were 35.48 ± 7.69 (out of 50) and 119.30 ± 23.28 (out of 165), respectively. A strong positive and significant correlation was found between EBP adoption and critical thinking (r = 0.677, p < 0.001). Linear regression analysis indicated that critical thinking explained 45.6% of the variance in EBP adoption (F = 251.90, p < 0.001). The findings underscore that nearly half of the variance in EBP adoption is explained by critical thinking, suggesting the need to prioritize critical thinking development in educational curricula. The findings suggest that critical thinking can significantly predict EBP adoption among nursing students, explaining 45.6% of the variance. Therefore, it is recommended that nursing education programs emphasize enhancing critical thinking skills to better prepare students for EBP.