Issue Analysis:

Caring for People in Poverty

Katrina Lindemann
Ashlee Knoll
 Learner Objectives
After reviewing this seminar presentation, the learner will be
able to:
● Describe healthcare disparities among those in poverty.

● Understand the barriers related to healthcare costs that limit the access
to medications and care.

● Define the nurses role in determining factors that negatively impact

ongoing medical coverage and advocate for community resources.

● Support local outreach programs by providing education and establishing

options for continuity of care.
 Introduction
● Defining poverty
● Poverty rates
○ Michigan 14.2%
○ United States 12.3%
● Vulnerable populations
● Limitations
● Healthcare

countyhealthrankin.org
Assessment
● Social
Determinants of
Health (SDOH)
● Healthy People
2020
● Preventative
Healthcare
● Reproductive
https://www.healthypeople.gov/2020/topics-
Health objectives/topic/social-determinants-of-health
https://poverty.ucdavis.edu/faq/how-does-poverty-relate-health-insurance-coverage
 Root Cause Analysis

Employment Housing

Healthcare
Insurance Disparities: Support System
Vestibulum conge
Patients in
Poverty

Transportation Public Safety

 Policies/Nursing Standards
Policies Nursing Standards of Care

❏ Medicare ❏ Standard 7: Ethics

❏ Medicaid ❏ Standard 13: Collaboration
❏ Obamacare/Affordable Care Act ❏ Standard 15: Resource Utilization
Inferences and Implications: Caring for
People in Poverty
❏ Nurses may identify bias towards patient which may interfere with care
❏ Increased costs for the hospital/ lack of complete care
❏ Increased hospital admissions/ER vists
❏ Failure to evaluate patient and identify lack in resources
❏ Insensitive interactions with staff
❏ Decreased trust of healthcare providers
❏ Provide safe, open environment
❏ Teach and advocate
❏ Evaluate learning style and ensure to teach patient at appropriate level
 Inferenes, Implications, and Consequences
Annie’s Story:
“I was diagnosed a Type I Diabetic when I was 25 years old. I was hospitalized after I
went into DKA with blood sugars as high as 1500. I was placed in the ICU where they
managed my symptoms and were able to get my system back on track. Since then, I
have struggled trying to find the right combination that works best for me. I have tried
using a insulin pump to deliver insulin more easily but it did not work well for me.
Instead, I use Lantus every night and novolog on a sliding scale around meal times.
Although I have a job, and have health insurance, I have experienced a lot of issues
obtaining my insulin due to cost. Last month I went two weeks without my long acting
insulin because the cost increased to $600 for a 30 day supply. I was forced to check
my sugar every two hours and administer insulin accordingly to maintain a healthy
blood glucose level. With the help of my nursing supervisor directing me to a local
resource called the Center of Hope, I was able to get my insulin at a more affordable
cost. Without their financial assistance, I would have ended up hospitalized again
(Somlar, 2019).
 Recommendations

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4832090/
Recommendations
 Conclusion

❏ Nurses serve as the first line of defense for patients in need

❏ Nurses who are aware of their own bias are better able to care for patients
❏ Michigan has a poverty rate of 14.2%, this leads to a large population of
patients in need of resources
❏ There are many health disparities that lead to a patient in need, be a listening
ear and make the difference in a patient’s experience with the healthcare
world
❏ https://youtu.be/-SCB1t28nDU
 Website, Questions, and Articles
Website: National Healthcare for the Homeless Council.
Link: https://www.nhchc.org/resources/clinical/tools-and-support/poverty-health/

Article 1: Surveying the hidden attitudes of hospital nurses’ towards poverty

Link: https://doi-org.ezproxy.ferris.edu/10.1111/jocn.12794

Article 2: The primary care provider and the patient living in poverty: Applying the Bridges to Health and
Healthcare model to NP practice
Link:https://journals.lww.com/jaanp/fulltext/2018/04000/The_primary_care_provider_and_the_patient_living.5.aspx

Question 1: As nurses, when caring for patients that are living in poverty, what are some of the biggest barriers
you have experienced when providing care? What did you do to overcome these barriers to assist your patient?

Question 2: Many communities and healthcare organizations have local resources they offer to patients and their
families. What are some programs that are in place within your organization or local community to provide to those
in need?
 References
American Nurses Association. (2012). The Essential Guide to Nursing Practice; Applying ANA’s Scope and Standards in Practice and
Education. Silver Spring, MD.

Center for American Progress. (2019). Poverty Data. In Talk Poverty. Retrieved from https://talkpoverty.org/poverty/

Centers for Disease Control and Prevention. (2018, January 29). Social Determinants of Health: Know What Affects Health. In Centers
for Disease Control and Prevention. Retrieved from https://www.cdc.gov/socialdeterminants/index.htm

Givens, M., Jovaag, A., & Willems Van Dijk, J. (2018). 2018 Michigan State Report . In County Health Rankings & Roadmaps.
Retrieved from http://www.countyhealthrankings.org/explore-health-rankings/reports/state-reports/2018/michigan

Health Quality Ontario (2016). Interventions to Improve Access to Primary Care for People Who Are Homeless: A Systematic Review.
Ontario health technology assessment series, 16(9), 1-50.

Herkert, D., Vijayakumar, P., & Luo, J. (2019, January). Cost-Related Insulin Underuse Among Patients With Diabetes. JAMA Internal
Medicine, 179(1), 112-114. doi:http://dx.doi.org.ezproxy.ferris.edu/10.1001/jamainternmed.2018.5008

Khullar, D., & Chokski, D. A. (2018, October 4). Health, Income, & Poverty: Where We Are & What Could Help. Health Affairs Health
Policy Brief. doi:10.1377/hpb20180817.901935
 References
Krumer-Nevo, M. (2016, September). Poverty-Aware Social Work: A Paradigm for Social Work Practice with People in Poverty. The
British Journal of Social Work, 46(6), 1793-1808. Retrieved from https://doi-org.ezproxy.ferris.edu/10.1093/bjsw/bcv118

National Health Care for the Homeless Council. (2019). Policy and Advocacy . Retrieved from https://www.nhchc.org/policy-
advocacy/

Smith, Jessica C. and Carla Medalia, Health Insurance Coverage in the United States: 2014, U.S. Census Bureau, Current Population
Reports, P60-253, Health Insurance Coverage in the United States: 2014, U.S. Government Printing Office, Washington, DC, 2015.

Schwartz, K. (2009). Health care for the poor: For whom, what care, and whose responsibility. Focus 26(2). Retrieved from:
https://www.irp.wisc.edu/publications/focus/pdfs/foc262l.pdf

UC Davis Center for Poverty Research. (2015). How does poverty relate to health insurance coverage?. In UC Davis Center for Poverty
Research. Retrieved from https://poverty.ucdavis.edu/faq/how-does-poverty-relate-health-insurance-coverage

U.S. Department of Health and Human Services. (2019, February 6). 2020 Topics and Objectives . In Office of Disease Prevention and
Health Promotion. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health

Wittenauer, J., Ludwick, R., Baughman, K., & Fishbein, R. (2015, March 6). Surveying the hidden attitudes of hospital nurses’ towards
poverty. Journal of Clinical Nursing, 24(15), 2184-2191. doi:doi: 10.1111/jocn.12794