Running head: CARING FOR PATINENTS IN POVERTY

Caring For Patients in Poverty

Jessica DeRuiter
Ferris State University

CARING FOR PATINENTS IN POVERTY

Abstract
Poverty in the United States is prevalent throughout the country. Those working in the healthcare
environment must be educated on available resources to help protect and improve the lives of
those affected by poverty. One of the responsibilities of the nurse is to advocate for and inform
the patient of available means for help and management of their condition. Poverty is a condition
that predisposes people to a variety of health related concerns. The following text will inform the
reader about poverty in the United States today, some health risks associated with poverty,
possible reasons for its prevalence, assess the healthcare environment, and provide
recommendations for quality and safety improvements.

CARING FOR PATINENTS IN POVERTY

Caring For Patients in Poverty

The issue of poverty can be relative to the location, economy, and population discussed
and is said to be complex and multidimensional in nature. Poverty is an age-long phenomenon
that besets mankind in our efforts towards development (Andy, 2011, p 1.) Poverty is present in
every community in every area of the world in one form or another. Poverty defined by the
World Bank is the economic condition in which people lack sufficient income to obtain certain
minimal levels of health services, food, housing, clothing and education generally recognized as
necessary to ensure an adequate standard of living (Andy, 2011, p. 1).
The impoverished population is in need of quality nursing care and education in the
hospital setting to prevent re-hospitalizations and enhanced patient quality of life. As a nurse,
one must be aware of resources available to this population. The purpose of this paper is to allow
readers to gain an understanding of poverty in the United States as it relates to the vulnerable
youth population, to define and understand related theories for practice, and to expand the
knowledge base of poverty to provide quality unbiased care in the practice setting. Questions and
biases discussed include; the medical communitys responsibility to educate people of poverty,
many assistance programs not offered to those in need. Is the poverty line to low or not low
enough? Can common health problems be prevented through hospitals educating those who live
in poverty?
Theory Base
The self-care theory is a nursing theory created by Dorothy Orem related to caring for
oneself. The theory is branched into three sections including theory of Self-Care, theory of SelfCare Deficit, and theory of Nursing Systems. Self-care is "the practice of activities that
individuals initiate and perform on their own behalf in maintaining life, health, and well-being"

CARING FOR PATINENTS IN POVERTY

(Cardinal Stritch University Library, 2011, p. 1). Focusing mainly on the theory of self-care, a
person in poverty can be taught how to overcome human limitations (Orem, 1959, p.4).
Poverty can be viewed as a vicious cycle. When living in poverty one is limited in resources that
the average person has such as food, clean water, a home, heat, clean clothes, transportation, and
health insurance or healthcare. A task of the nurse is to evaluate the patient situation and help
provide a means for support by offering assistance through local resources. The nursing process
is used while assessing patients and functioning within this theory. That process includes the
initial assessment, the nursing diagnosis, a plan with rationale, implementation, and evaluation.
Once complete, the nurse can determine the patients health status, health goals, design a system
that holistically treats the patient, assist the patients and families to create and maintain
healthcare goals related to self-care and evaluate the results (Orem, 1985).
A theory that can be examined unrelated to the field of nursing is the cultural theory of
poverty. This theory was created by Oscar Lewis and Oliver La Farge in 1959 and it states that
poverty is a product of ones culture. The culture of poverty presupposes that the poor has [sic]
unique patterns of behavior and priorities of values that distinguish them and these unique
characteristics always cause them to be trapped by poverty (Andy, 2011, p. 2). This theory ties
in with that of Orems self care theory. Being trapped by poverty is a limitation that must be
overcome to break the cycle. However to overcome poverty one must be educated on various
methods of exit. Some people are born into poverty and are not interested in the health risks
associated with it or the benefits of overcoming it. A set of values are transmitted
intergenerationally through the process of socialization and have become the subcultural
determinants of the lower socio-economic status of the poor and this leads to a vicious cycle of
poverty and is [sic] only a few who are able to get out of the poverty cycle (Andy, 2011, p. 2)

CARING FOR PATINENTS IN POVERTY

Assessment of the Healthcare Environment

In 1963, Mollie Orshansky of the U.S. Department of Agriculture came up with a figure
to define poverty in the United States. She set the poverty level based on three times what a
family would have to spend on a mediocre diet. A mediocre diet is one that is sufficient but not
organic or entirely health conscious. (State of Michigan, 2014). The poverty line is dependent
upon the number of people within your household, their ages, and the income of all combined,
see Appendix A. The poverty line is updated every year by the United States Census Bureau.
Resources available to people below the poverty line set by the State of Michigan include
Women, Infants & Children (WIC), the supplemental nutrition assistance program (SNAP), head
start, free lunch programs at school, food banks, soup kitchens, church pantries, Supplemental
Security Income (SSI), and Childrens Health Insurance Program (CHIP), local help includes MI
child (Michigan health insurance for children), local Health Departments, and free clinics.
WIC
Each month, more than 200,000 moms, babies, and children less than age 5 receive
nutritious foods from the Michigan WIC Program. WIC foods are worth $30-$112 or more per
month for each participant (State of Michigan, 2014, p. 1).
WIC participants receive help with nutrition education and breastfeeding, as well as
referrals to other health services. One out of every two babies born in Michigan receives WIC
benefits. The earlier a pregnant woman receives nutritional benefits from WIC, the more likely
she is to seek prenatal care and deliver a normal weight infantFor every dollar spent by this
program, more than three dollars in subsequent health care costs are saved (State of Michigan,
2014 p. 1). A family of four is able to earn $40,000 per year pre tax and still qualify for WIC

CARING FOR PATINENTS IN POVERTY

benefits. The WIC program is more generous when it comes to providing assistance related to
the poverty line than other resources.
SNAP
SNAP requires a net monthly income of $1,650 or below for a family of four to qualify
for benefits. SNAP, formerly called the Food Stamp Program, provided almost $72 billion in
benefits to people in 2011. SNAP is the largest U.S. food assistance program, providing 44.7
million individuals with an average monthly benefit of $134 in 2011 (State of Michigan, 2014).
The program is able to benefit some, but not all, of the poor community. A beneficiary would
need to meet other requirements, such as not having countable resources totaling more than
$2,250, and making less than $19,800 a year. Families recently unemployed with a small savings
would not be considered until much of their funds are gone.
Joblessness/working poor
Although the working poor are a much larger population than the unemployed poor,
U.S. poverty research devotes much more attention to joblessness than to working poverty
(Brady, Baker, & Finnigan, 2013, p. 872). Since the working poor are overlooked they are not
included in statistical data and the issue is greater than many know. The working poor are the
most prevalent population in poverty next to children under 18. Of the 19.9 million people with
a family income below one-half of their poverty threshold, 6.5 million were children under age
18 (Cameron, Proctor, & U.S. Census Bereau, 2014, p. 17).
The lack of unions in the United States is one reason thought to increase poverty rates for
the working poor. According to Bradly et al.,(2013) state-level unionization reduces working
poverty (p. 874). Studies have determined low wages contribute to poverty. Union members
receive a 20 percent wage premium over similar non-union workers. Because wages are a large

CARING FOR PATINENTS IN POVERTY

share of low-income households economic resources, such wage advantages could lift many
households out of poverty (Brady et al., 2013, p. 875)
Inference/Implications/Complications
An assumption many people share is that the poor are jobless and do not work.
According to Brady et al., (2013) studies are not completed on this population as many people do
not believe it to be necessary. The evidence regarding people in poverty is divided between
studies claiming poverty is more prevalent in the working poor and that the working poor are the
most typical poor (Brady et al., 2013). Newer evidence is proving that people can live in poverty
while maintaining full time employment and that poverty does not only affect people without a
job.
Unionization
Many factors contribute to the unequal distribution of wealth in the United States and
currently there are not many solutions in place to help provide positive outcomes. One factor
attributed to the increased poverty rates is the lack of unions. The neglect of unionization in
studies of working poverty is also unfortunate given that the decline of unionization contributed
to increases in earnings inequality (Brady et al., 2013, p. 873). The unequal pay and wages are
activities responsible for much of the poor community. Without a union in place to provide
regulations, the poverty levels will not improve. The poor will continue to get poorer as the cost
of living goes up and the rich will continue to get richer.
Demographics, economic performance, and social policies are also said to be responsible
for poverty risks and rates. Access to healthcare and healthcare costs for both disabled and the
average citizens pose a big risk.

CARING FOR PATINENTS IN POVERTY

Being born into poverty and living within the vicious cycle as the Cultural Theory of
Poverty describes contributes to the rates of poverty. The outcomes describes in this theory are
not positive ones. Those born into poverty remain there and only a few are able to escape. An
analysis of this theory to the explanation of poverty is very important in development because, it
helps us to know how culture influences development because culture is a constitute part of
development (Andy, 2011, p. 3)
Recommendations for Quality and Safety Improvements
Quality Improvement is a QSEN competency which can be used in relation to caring for
those in poverty. This competency uses data to monitor the outcomes of care processes and uses
improvement methods to design and test changes to continuously improve the quality and safety
of healthcare systems (QSEN, 2012, p. 3). The rates of poverty can be more closely monitored
to determine a cause and effect. Once determined one can more easily come up with strategies
for improvement and prevention of poverty in the United States in those who do not wish to live
that way. The nurse can study these rates in relation to her community. The study could be
especially helpful to the public health nurse.
Patient Centered care is also a QSEN competency that needs to be evaluated in relation to
poverty. Patient-centered care recognizes the patient or designee as the source of control and
full partner in providing compassionate and coordinated care based on respect for patients
preferences, values, and needs (QSEN, 2012, p. 3). The nurse can incorporate the self-care
theory and patient centered care to assess, implement, plan, and evaluate the patient. The nurse
can find resources available such as health clinics, free lunch programs and WIC to offer support
to the patient and patients family.

CARING FOR PATINENTS IN POVERTY

Informatics can be used to assess cost of living expenses and wages related to rates of
poverty. Nurses can use technological resources to enroll, contact, educate, and refer patients to
services available in the area the patient lives.
ANA Standards to focus on pertaining to people in poverty are Standard 8- Education,
Standard 15- Resource Utilization, and Standard 16- Environmental Health. Poverty rates are
increased and occur most often in households who have lower education levels (Cameron et al.,
2014). Many young people cannot afford to get an advanced college education. Many do not
even have a high school diploma as they are forced to drop out of school to help keep food on the
table for their families (60 minutes, 2011).
Resource utilization can be attained through education. The nurse can assist patients in
poverty to be aware of and utilize all available resources for which they qualify. People are poor
in life because of their inabilities to compete with others for resources (Andy, 2011, p. 1). Those
who can get assistance, even for a short time, increase their chances of breaking the vicious cycle
of poverty.
Environmental health is an important standard of care that the health care team needs to
incorporate into the patient care of those living in poverty as their access to clean water, shelter,
and healthy foods may be limited. Common health problems, due in part to poverty, are a lack of
immunizations, common infectious diseases, sleep deficits, vision and hearing deficits,
nutritional deficits, dental care problems, injuries, adolescent pregnancies and STIs, and mental
illness (Ball, Bindler, & Cowen, 2011). Providing resources to people in poverty to prevent these
problems will improve quality of life for patients and their families.

CARING FOR PATINENTS IN POVERTY

10
Conclusion

Many people in poverty are discriminated against and assumed to not be productive
members of society in the labor market. As mentioned, some believe people in poverty do not
work and therefore do not contribute to society nor are they included in studies related to
poverty. More recent studies show that people in poverty are in fact a large sum of the working
class. As disease and health complications are prevalent throughout the poor community,
curative and preventative resources are available. These resources can be met through education
and references provided by the nurse. On assessment of the patient, the patients education level,
and local resources the nurse can come up with a care plan that fits the patients needs and
budget. As one of the wealthiest nations in the world it is highly unacceptable for the United
States to maintain such high poverty levels. We must be the change we want to see in the world
and remove our biases to help those in need for their future and ours.

Appendix
A

CARING FOR PATINENTS IN POVERTY

11

CARING FOR PATINENTS IN POVERTY

12

References
60 Minutes. (2011). Children in Poverty: This is Why the American People are Fed up with this
System.
American Nurses Association [ANA] (2010). Nursing: Scope and standards of practice (2nd
ed.). Silver Spring, Maryland: American Nurses Association.
Andy, E. (2011). Critical analysis of poverty theories. academia.edu. Retrieved from
http://www.academia.edu/1116707/Critical_Analysis_of_Poverty_Theories
Ball, J., Bindler, R., & Cowen, K. (2011). Principles of pediatric nursing caring for children (5th
ed.). Boston: Pearson.
Brady, D., Baker, R. S., & Finnigan, R. (2013, September 25). When unionization disappears:
State-level unionization and working poverty in the United States. American Sociological
Review, 75(5). http://dx.doi.org/10.1177/0003122413501859
Cardinal and Stritch University Library. (2011). Dorothea Orem 1914- Self-care Framework.
Retrieved from
http://library.stritch.edu/research/subjects/health/nursingTheorists/orem.html
Cameron, D., Proctor, B. D., & U.S. Census Bereau (2014, September). Income and poverty in
the United States: 2013. U.S. Census Bureau. Retrieved from
http://www.kushima.org/is/wp-content/uploads/2014/09/p60-249.pdf
Orem, D. (1985). Nursing: Concepts of practice. In Nursing: Concepts of practice (3rd ed.). St
Louis, MO: Mosby.
Orem, D. (1959). Guides for developing curriculum for the education of practical
nurses. Washington, DC: U.S. Government Printing Office

CARING FOR PATINENTS IN POVERTY

13

QSEN (2012, September 24). Graduate-level QSEN competencies Knowledge, skills, and
attitudes. American Association of Colleges of Nursing. Retrieved from
http://www.aacn.nche.edu/faculty/qsen/competencies.pdf
State of Michigan (2014). Department of Community Health. Michigan Department of
Community Health. Retrieved from http://www.michigan.gov/mdch/0,1607,7-1322942_4910---,00.html
Tiehen, L., Jolliffe, D., & Gundersen, C. (2012, April). Alleviating poverty in the United States:
The critical role of SNAP benefits. United States Department of Agriculture, (132).
Retrieved from www.ers.usda.gov