Nursing the Impoverished

By Calvin Petersen

It’s no secret that poverty is a big problem. The American Council on Science and Health went so far as to call it “the world’s deadliest problem.” In fact, nearly 29,000 children under the age of five die every day because of poverty, according to UNICEF. As global leaders struggle to find solutions, nursing students at BYU have found a unique way to develop understanding and compassion for the impoverished.

An Exercise in Empathy

As they learn the Healer’s art, fourth-semester nursing students at BYU gain Christ-like empathy for their patients by participating in a poverty simulation.

First put together by Missouri Community Action, the simulation creates a realistic community of more than 20 volunteers who act as bank tellers, pawnbrokers, grocery store cashiers, school teachers, mortgage collectors and other community personnel. Eighty students populate the simulated community as they role-play the lives of low-income families. Nursing assistant teaching professor Gaye Ray and Provo Community Action executive director Karen McCandless organize the simulation each semester.

Poverty Simulation 1

(From left to right) Joanna Ostler, Shelby Benally, Amy Sutherland and Jane Goodfellow review their poverty simulation packet moments before the simulation begins.

“We hope that, by inviting you to walk in the shoes of the impoverished, in a small way you will understand what it’s like to have a shortage of money and an abundance of stress. We hope you will be more sensitive to the feelings of those who are living in crisis and be more thoughtful in your future careers,” Ray told students before the winter 2018 simulation.

Students participating in the simulation were randomly assigned to one of 16 different families. Each family was given a packet with information describing the family’s situation and its individual members, based on real-life stories and people.

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Students only had a few minutes to make sense of the transportation passes, identification cards, bills and money that spilled from the thick manila envelopes before the whistle blew. Then the first of four 15-minute simulated weeks began. And chaos followed.

The Boling Family Strikes Out

As students raced to their jobs, school, the bank, the grocery store and other community stations, five students, role-playing as members of the Boling family, quickly realized how stressful the poverty simulation would be.

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To begin with, because 42-year-old Ben Boling, (portrayed by Shelby Benally) recently lost his job, the family barely had enough money to purchase transportation passes so that 39-year-old Betty Boling (portrayed by Mary Erdman) could get to her full-time job.

Luckily the school bus picking up the Boling’s three children, pregnant 16-year-old Barbara (portrayed by Amy Sutherland), eight-year-old Brian (portrayed by Jane Goodfellow) and 10-year-old Bart (portrayed by Joanna Ostler), was free.

However, after only a week, Ben Boling had a stroke and was hospitalized for the remainder of the simulation. To make things even more stressful, Barbara was expelled from school and the two boys were suspended for cheating. “I didn’t cheat,” promised Brian. “Stop lying Brian,” scolded Bart. “I’m not lying, you’re a liar!” countered Brian. Betty tried to put on a brave face as her family fell apart around her.

Poverty Simulation 2

Ben Boling (left, portrayed by Shelby Benally) fills out an employment form during the first week of the poverty simulation.

The last three weeks of the simulation were hard. At one point, Barbara was taken by the sheriff to juvenile hall for possession of illegal drugs. Then the electricity was shut down because the Boling mother couldn’t make the payments. “This is so stressful!” said Betty, “I feel like I’m the only one taking care of things. I work full-time, so I don’t have time to buy food and pay bills, my husband is out and I have three kids.”

In the final week of the simulation, the sheriff arrived to take Betty to jail for defaulting on a bank loan. Barbara tried to cash Betty’s last check to make bail, but the bank refused to help an underage customer. Barbara looked around frantically, hoping for some aid in a hopeless situation. Then the whistle blew a final time and the simulation ended.

Although the simulation may have not been real, the stress was real and every student came to know, if just for a moment, part of what it feels like to be impoverished.

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Bankers deny Barbara Boling’s (portrayed by Amy Sutherland) request to cash her mother’s paycheck.

Determined to Do Something

The impact of the poverty simulation on the 80 BYU nursing students was evident in the discussion afterwards.

“I learned to have more patience with people because you never know what’s going on in their lives,” said Emily Santillan. “It’s easy for us as nurses to say, ‘Why aren’t you taking your meds? Why aren’t you eating your fruits and vegetables? It’s so important; why aren’t you doing these things?’ But we don’t see the whole picture. We have to be patient with them.”

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Because she discovered some of the available community resources, Emily Miller’s simulation family did better than most. “I feel like, as a nurse, I need to be more aware of resources that are available in the community to best help my patients,” she said.

Provo Community Action is one such local resource for low-income families. Executive Director Karen McCandless smiled as she listened to the nursing students’ experiences. “This last part is always really satisfying for me because it tells me that the simulation did its job,” she said.

McCandless joined Provo Community Action five years ago in part because of her personal experience in a poverty simulation. “I thought I was a compassionate person to begin with, but this poverty simulation, it literally changed my thinking. That was my hope here: that students would leave a little more compassionate than when they walked in.”

The poverty simulation taught BYU nursing students that while they may not be able to solve the “world’s deadliest problem” of poverty overnight, they can help solve the health challenges of their patients today. “Even though we can’t change their whole world with just one act, we can do something,” concluded nursing student Lauren Young.

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BYU College of Nursing professor Gaye Ray (left) and Provo Community Action Executive Director Karen McCandless (center) talk to students about the winter semester poverty simulation.

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