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SPOTLIGHT ON POVERTY: CARING FOR PATIENTS WITH VARYING

VALUES AND BEHAVIORS

Kimi Yuchs MA (N), RN, NE-BC

Healthcare Consultant

Assistant Professor of Nursing

Hannibal-LaGrange University

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Objectives

Participants will be able to:1. Understand the culture of poverty and

middle class.2. Analyze how the issues of poverty

impact health care.3. Understand how the hidden rules

among classes determines behavior and choices.

4. Understand how patterns of language impact the care of and working with individuals from generational poverty.

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What is this really about? Transforming our consciousness

and practices Challenging ourselves, our biases

and prejudices, by educating ourselves about the cycle of poverty

Using our knowledge to provide effective advocacy for our patients

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Culture

The total system of beliefs, values, attitudes, traditions, and standards of behavior that regulate life within a particular group of people and are thought necessary for their survival in the context of their environment. It is self-reinforcing in nature.

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Key Understandings

1. Poverty is relative and based on survival.2. Poverty occurs in all races.3. Poverty is a culture.4. Generational and Situational poverty are

different.5. Healthcare operates from middle-class norms

and values.6. Each economic class has hidden rules.7. Understanding the issues related to poverty will

enable healthcare professionals to better care for and support those individuals with limited resources.

Source: Ruby Payne, A Framework for Understanding Poverty

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External and Internal Resources 1. Financial 2. Emotional 3. Mental 4. Spiritual 5. Physical 6. Support Systems 7. Knowledge of middle-class “hidden

rules” 8. Role models

Source: Ruby Payne, A Framework for Understanding Poverty

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As health care workers if we are…

Focusing on our own “circle of influence” Expanding our knowledge and

understanding of poverty and its related issues

Taking time to “know” our patients/employees

We will make a difference in the lives of those patients with limited resources.

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Language Issues and the Impact on Effective Communication

“…language is the most significant determinant of economic and social well-being.”

Wayne Harbert, Cornell Professor of Linguistics

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Discourse Patterns

Primary discourse – the language an individual first acquires as a child.

Secondary discourse – the language of the larger society that the individual must be able to communicate in while participating in the larger society.

Gee, James (1987)

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Story Structure

FormalStraight to the point with a clear beginning, middle and end.

CasualGoing around and around before getting to the point. It usually begins with the end of the story first. Often it is more about the people than the issue. It involves a lot of commentary about the people involved.

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“Hidden Rules” of Poverty and the Middle Class Hidden rules are the unspoken cues and habits

of a group. There are distinct, differing value structures for

economic classes. We usually recognize this with different ethnic

groups but not with economic classes. Individuals in each group assumes everybody

knows their “hidden rules.”

Based on Ruby Payne’s A Framework for Understanding Poverty

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Surviving In Poverty

___Do you know what churches and other organizations have food and clothing pantries?

___Do you know when Salvation Army has their “bag sales”?

___Do you know what grocery stores or restaurants have open garbage bins that can be accessed for thrown-away food?

___Do you know how to get someone out of jail?

___Do you have the strength and weapons to physically fight and defend yourself?

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___Do you know how to get a gun with a police record?

___Do you know how to keep your clothes from being stolen at the laundromat?

___Do you know how to live without a checking account?

___Do you know where you would go if you were evicted? Could you move in a half day?

___Do you know how to live without electricity or a telephone or a car?

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Surviving in Middle Class___Do you talk to your children about their

futures and going to college?___Do you know how to set a table

properly for entertaining family and friends?

___Do you have favorite stores that carry certain brand names of clothing?

___Do you have a schedule for taking your children to their extracurricular activities?

___Do you know how to get the best interest rates on car loans, credit cards, savings accounts, etc?

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___Do you know how to help your children with their homework?

___Do you have a library card or membership to the YMCA or other clubs and organizations?

___Do you understand principal, interest, and escrow statements on your house payment?

___Do you call a repair service take care of roof, plumbing, or electrical problems?

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Surviving in Wealth

____Do you have your own plane or company plane?

___Do you know how to read menus in French, Italian, and English?

___Do you have at least two residences that are staffed and maintained?

___Do you have at least two or three people to screen people whom you do not wish to see?

___Do you host parties designed for “key people” to attend?

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Driving Values for Those Living in Poverty Survival Relationships Entertainment

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Driving Values for Middle Class

Work Achievement Financial security

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Driving Values for the Wealthy

Financial, political, and social connections.

A Pattern of Characteristics Background noise/dark Significance of entertainment Importance of personality/humor Importance of relationships Matriarchal structure Casual register Survival orientation

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Cont.

Negative, polarized thinking Belief in fate- no options or

choices-one is fated Time relates to the present

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IMPACT ON CARE

Think about the following issues in dealing with clients/ patients:CooperationCompetitionAuthorityDeception

How do these characteristics surface when working with individuals living in the Culture of Poverty?

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Implications

The culture and belief systems that we bring with us drive our attitudes, decisions, and behavior.

The judgments and assumptions we make about individuals’ intelligence and approaches to life are often biased by our failure to understand the “hidden rules” and characteristics under which they live.

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An understanding of poverty will decease the anger, frustration and prejudice the we may feel when working with individuals with limited resources.

STEPS WE CAN TAKE

Recognizing our biases Seeking to understand Increasing the trust factor Get to know the human being

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“When we can no longer change a situation, we are challenged to change ourselves.”

- Viktor Frankl