No doubt the implementation of the Affordable Care Act will have a profound effect on near future health care environments as 32 million Americans who are now uninsured will have access to health care. Consequently, our graduates will care for increasingly diverse populations. That diversity will include patients who struggle because of social economic status just on the edge of poverty. This quarter we are piloting a low technology/high fidelity simulation experience to facilitate the development of knowledge and attitudes needed to care for populations in that very circumstance. We piloted the Poverty Simulation on the Ashland and Portland campuses. Students participated in a half-day experience that includes immersion in a community positioned at the edge of poverty. Instead of assuming the role of the nurse, students were assigned to play a role in a family and must manage their lives as a variety of events unfold. The families face several common challenges such as an episodic illness without insurance, disruption in employment and difficulty with transportation.The scenario runs over a compressed four week time blocks and students must navigate through work, school, social services, banks and day care. Soon families find themselves living in chaos and many experience many health related problems. Learners quickly find themselves identifying and examining labels, stereotypes and judgments such as "non-compliance" and "laziness".

Faculty have collaborated across campuses to implement an innovative simulated learning activity and are conducting a multi-site study to determine if this simulation facilitates development of intended learning and understanding. Students on all campuses are taking a well- designed survey with established reliability and validity that assesses understanding and empathy around low social-economic communities. The study includes a pre/post test design and our Klamath Falls, La Grande, and Monmouth students are serving as the control group as only Ashland and Portland students will participate in the simulation. The research team led by Dr. Joanne Noone will analyze the data and disseminate the findings. Faculty intend to establish the value added regarding the intended learning. This educational research project creates opportunity for scholarship and innovation. It also represents the OHSU School of Nursing's first systematic study that will contribute to establishing best practices in simulation. Most importantly, the study will inform teaching and learning strategies that will assure our graduates develop the knowledge and understanding needed to competently care for diverse populations in an era of health care reform.


The "Advancing Care Excellence for Seniors" (ACES) project is designed to assist faculty to incorporate simulation and unfolding case studies to enhance nursing students' expertise in gerontologic nursing.The project, begun in 2010 and ongoing over the next few years, is a collaboration between the Community College of Philadelphia and the National League for Nursing, was funded by The John A. Hartford Foundation, Laerdal Medical Corporation, and The Independence Foundation.Pamela Jeffries, DNS, RN, FAAN, ANEF, is the Project Director, and case study authors are: Teri Boese, MSN, RN, Mary Cato, MSN, RN (OHSU Portland campus SoN faculty), Jeanne Cleary, MA, RN, and Cynthia Reese, PhD, RN, CNE.

The authors were charged with creating unfolding cases of older adults.Each case includes monologues, three simulation scenarios, and an instructor toolkit containing many resources which faculty and students can utilize to learn the complexities of gerontologic care.Concepts included are varied settings, family dynamics and role strain, common syndromes of aging, differences in responses of older adults to illness, evidence-based practice, and a multi-disciplinary team approach to care. A final piece of the cases is a student assignment to "Finish The Story," imagining what life will be like for each of the patients months after their last encounter.

One case, "Julia Morales and Lucy Grey," authored by Mary Cato, was piloted on the Portland campus in fall of 2010, and the simulation scenarios are now incorporated into our database and will be used in the winter Chronic Care course.To learn more about the ACES project and the other patients, (Sherman "Red" Yoder, Henry and Ertha Williams, and Millie Larsen), please see the NLN Faculty Development site.

will be happy to discuss the project further and answer any questions.