A New Perspective

Sometimes the realities our patients face are far from what we ourselves have experienced.

A senior may need medication but not have transportation to get to the pharmacy.

Children might live in a neighborhood where shootings are common. A single parent may regularly run out of food to feed her family well before the next payday.

Health care providers, community leaders and students and faculty from Vanderbilt University School of Nursing (VUSN) and other area universities learned to see life through their patients’ eyes with an innovative poverty simulation program facilitated by two VUSN faculty members and staffed by volunteers from a nearby low-income neighborhood.

The experience was so profound that VUSN has made it a requirement that all first-year students go through the simulation; eventually, all VUSN students and faculty will experience the exercise.

Edgehill Family Resource Center Director Brenda Morrow recruited community volunteers to participate in the simulation. Afterward, she spoke about the value of seeing through others’ eyes. Photo by Anne Rayner.

Faculty member Jannyse Starks, DNP’11, MSN’09, FNP-BC, and Tamika Hudson, MSN’12, APRN, FNP-C, CLC, facilitated the simulation. “We believe it is important to provide our students with a firsthand view of what it is like to live in poverty,” Starks said. “Our hope is that it will provide a sense of acknowledgement, awareness and empathy that will better prepare students to be competent and compassionate providers.”

Hudson sees immediate value in the program. “The patients we serve are representations of the evolving country we live in,” Hudson said. “It is imperative that students develop sound knowledge regarding social determinants of health and key predictors of health outcomes. Sensitization to patient scenarios that differ from students’ culture and customs is essential to providing culturally competent care.”

Starks and Hudson brought the simulation to Vanderbilt after attending a conference on the impact of poverty in 2016. They conducted their first Community Action Poverty Simulation in June 2017.

In it, they asked participants to take on the roles of low-income family members living on a limited budget and dealing with various true-life scenarios. During the three-hour exercise, the participants had to provide for their families, maintain their residences and interact with various agencies and businesses for the equivalent of a month. They also had to deal with unexpected challenges like missed rent payments, evictions, visits from truant officers, crime and lack of transportation.

To make interactions more realistic, the roles of employers, pawnbrokers, social service workers, health care professionals, police officers and other resource providers were played by community residents who have experienced poverty and could respond as real-life providers do — and not always helpfully.

The simulation wrapped up with a feedback session with all participants. Students, faculty and community leaders related how difficult they’d found their roles, concurring that the exercise had given them a new perspective on the challenges facing many of their patients and neighbors. The community residents reported that the exercise gave them feelings of empowerment. Many mentioned the benefit of being able to tell their stories and thanked the group for wanting to educate people about the complexity of poverty.

“Living in poverty is so hard to imagine for us who’ve never struggled in the same way,” one student wrote on a feedback form. “The perspective I gained is truly invaluable and has certainly changed my understanding of daily life for many people. I especially appreciated having the Edgehill community members there to run the stations and share their reflections — while heartbreaking to see the struggles they face, hearing their perspectives was definitely a highlight of the afternoon.”

Participants were amazed to find themselves waiting in line a lot. With scarcity of services, that’s a reality for many low-income people. Photo by Anne Rayner.

Natasha McClure, DNP, MSN’11, was a participant. The assistant professor co-coordinates Vanderbilt’s Community and Population Health course series for first-year students and also runs an asthma education program in a local school. It reminded her how important it is to look beyond her own viewpoint.

“When we learn parents miss a clinic appointment for their child’s asthma care, I usually don’t think it is due to lack of concern,” McClure said. “Parents living in poverty are struggling to meet basic needs for their children: a place to live, keeping them physically safe, providing food and clothing. It is living in a constant crisis, which results in chronic stress and degrades emotional resilience. Asthma can’t be the top priority when a family is struggling with becoming homeless.

“One family we have worked with had a really difficult time even keeping home visit appointments,” she continued. “It is a single mom raising 11 children — several of whom she is caring for due to other family members being incarcerated. She is keeping those kids out of foster care. I understand her priorities and need to do what I can to make caring for her child’s asthma easier on her. We earned her trust by treating her with dignity and respect.”

McClure said that the most important takeaway from the simulation was stripping away the unconscious bias that can exist when we don’t understand people’s choices and how they set priorities. “The simulation helped everyone to see that none of the choices are really choices at all for families living in poverty,” she said. “It can quickly become a cycle of chaos for families when a child has an asthma exacerbation and has to be hospitalized.”

The simulation was co-sponsored by the School of Nursing and the Vanderbilt University Office for Equity, Diversity and Inclusion.

In addition to students and faculty from the School of Nursing, participants included representatives from the College of Pharmacy at Lipscomb University, Fisk University, Meharry-Vanderbilt Alliance, Mercury Court Clinic, Metro Nashville Public Schools, Middle Tennessee State University, Peabody College and Vanderbilt School of Medicine.

—Nancy Wise