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"In Their Shoes": Award-Winning Program Teaches Students About Barriers to Accessing Health Care

Posted: July 17, 2014

Austin is one of the fastest growing cities in the United States today. Sadly, its low-income population is growing almost as fast. Between 2000 and 2011, the number of people living in poverty in the city’s suburbs grew by more than 140 percent; and 28,000 children, or 15 percent of juveniles, live in extreme poverty. And although agencies offering various health and social services stand ready to help, accessing them can be difficult, if not almost impossible, for many low-income individuals, which only adds to a burgeoning health-care crisis.

When students at The University of Texas at Austin School of Nursing were recently assigned to go into the community to locate health care resources, they quickly found out just how difficult it is for this growing number of Austin residents to get the help they need for their children and themselves.

The exercise was part of a new teaching program created by School of Nursing faculty. The idea is that rather than merely read scenarios out of textbooks about clients in need of various services, the students were told to assume a real-life identity — such as a homeless hurricane victim needing hypertension medication or a young single mother with an ill child — and then locate an agency providing the needed assistance. And get there by public transportation.

Karen Johnson and Nancy Guillet

Karen Johnson, assistant professor, and Nancy Guillet, clinical nursing instructor​

Although understanding the ways that poverty influences health affects how nurses interact with low-income clients, most nursing schools do not include curricular content on poverty. That’s why Karen Johnson, assistant professor, and her colleagues at the UT Austin School of Nursing were determined to bring to life the many challenges faced by Austin’s underserved populations.

During the lecture portion of her public health classes, Johnson was concerned that she wasn’t getting through to her senior-level nursing students about the barriers low-income people face accessing health care. She felt they weren’t grasping issues of social mobility, where health and socioeconomic disparities come from, and how these are related.

“I wanted them to understand how difficult it is to connect patients to resources,” Johnson said. “It’s a full-time job to get bare bones benefits while holding down a job or working on an education.”

Johnson took her concerns to colleagues Nancy Guillet and Linda Murphy, instructors in clinical nursing, Ana Todd, assistant professor of clinical nursing, and Shalonda Horton, assistant instructor. As a group, they discussed the importance of having the students experience firsthand what it is like for individuals to seek out these services.

“I said I wanted the students to really feel the frustration so many people experience and how hard it is to live with limited opportunities,” said Johnson. “I asked 'How can we get them to walk a mile in their shoes?’ — and that was it! What we hoped to accomplish and how to make it happen was summed up in that phrase.”

“Drawing on our own experiences in public health nursing practice, we developed several case scenarios of clients in need of services for which public health nurses often provide case management, referral and follow up,” said Guillet. “And all travel had to be done by public transportation to get a sense of how much time getting from one agency to another can take.”

That alone was an eye-opening experience for most of the students.

“We make assumptions that there are benefits available, but if people don’t have valid identification or documents, they can’t get the help they need,” a student said after one frustrating outing. “I took an entire morning and still got nothing done.” According to another, “I didn’t know there were north-bound and south-bound buses!”

Others complained that the information they had researched online about hours of operation and documents they needed to bring with them was often inaccurate. The extent of the challenges involved began to dawn on them.

“Now I have a better understanding of how difficult it can be to access these resources,” said one student. “It’s not laziness. It’s a real challenge for people to miss work and spend a day on the bus.”

The experiment has been a resounding success, according to Guillet. “In addition to the challenges low-income clients must deal with, the students got a sense about how nurses can help, can be part of the solution. Regardless of their area of practice, nurses need to apply public health concepts when referring clients to community resources.”

This spring “In Their Shoes” received the School of Nursing’s Innovations in Teaching award. The award recognizes teaching strategies that create a learning environment that encourages students to take risks, be creative, and actively engage in learning that expands their knowledge and helps them explore new ideas.

“Our public health faculty are continuing to coordinate efforts so that students get the best experience and can apply that in real-life situations,” Guillet explained. “This exercise puts it all together for them.”

The students agree. “This opened a new dimension of advocating for patients and helping them find solutions,” one student said. “I will put more care and emphasis on my clients’ living situation and consider the feasibility of the suggestions I make.”