Creating empathetic nurses

With basic survival being so complicated, it was no wonder that most participants didn't prioritize a visit to the doctor over other necessary errands, or their medication over food for their families.

"Healthy choices were not a priority because Maslow's hierarchy: if your basic needs are not met, then nothing else matters," Pitre said. "(My character) was also 16 and pregnant and trying to get through school and that was really hard ... Healthy lifestyle choices were not even on my mind."

When patients don't follow medical advice, nurses must take into consideration the obstacles that might be in their way, Dr. He said.

"As health care providers, before we label a patient 'noncompliant,' let's look at why," she told the students. "If they don't have the chance to purchase food, whatever healthy lifestyle choices that we recommend, of course they're not going to be implemented."

For many students, the simulation was not entirely unfamiliar. Several mentioned that it rang true to their own experiences growing up, with a few noting that it made them more appreciative of what their parents did to provide for their families.

"It sounds like it surprised some people (that people go through this)," said nursing student Carl Allen. "I hope this helps whoever's thinking that realize that this is real life for a lot of people. I grew up like this, so now I'm just realizing even more how much my dad really had to do for us."

The poverty simulation is a kit created by the Missouri Community Action Network, purchased by the CSUB Nursing Department with funds from two grants: a U.S. Department of Health and Human Resources (HHS) Health Resources and Services Administration (HRSA) Advanced Nursing Education Workforce (ANEW) Program award and Nurse Education, Practice, Quality and Retention (NEPQR) Simulation Education Training (SET) Program award.

The simulation was first held in February, led by representatives from the Missouri Community Action Network. Dr. He plans to hold a poverty simulation every semester, with one already in the works for spring.

"Health outcomes are so poor in the community, and I think we have the obligation, as a school and a department, to do what we can to improve them," Dr. He said. "We have to look at the root cause. We can't just ask people to buy something healthy while they're in a food desert. You can't make people go exercise when they're in an environment that's not safe to be outside. We really should understand the social determinants of health, and poverty is one of those things that affects every aspect."

Future nurses aren't the only ones who can benefit from this practice in empathy, so Dr. He hopes students in public health, social services, education and other relevant majors consider joining an upcoming poverty simulation. Future teachers especially might come away from the simulation understanding why attending school or finishing homework isn't always the top priority for their students.

"When we look at why our educational attainment is so low, you have to look at the whole picture," Dr. He said. "Having that empathy and understanding is important."

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