1. 8/15/20151 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

2. 8/15/20152 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.

3. 8/15/20153

4. 4 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

5. 8/15/20155 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.

6. 8/15/20156 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

7. 8/15/20157 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

8. 8/15/20158 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.

9. 8/15/20159 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

10. 8/15/201510 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)

11. 8/15/201511 Story Structure Formal Straight to the point with a clear beginning, middle and end. Casual Going 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.

12. 8/15/201512 “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

13. 8/15/201513 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?

14. 8/15/201514 ___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?

15. 8/15/201515 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?

16. 8/15/201516 ___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?

17. 8/15/201517 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?

18. 8/15/201518 Driving Values for Those Living in Poverty Survival Relationships Entertainment

19. 8/15/201519 Driving Values for Middle Class Work Achievement Financial security

20. 8/15/201520 Driving Values for the Wealthy Financial, political, and social connections.

21. A Pattern of Characteristics Background noise/dark Significance of entertainment Importance of personality/humor Importance of relationships Matriarchal structure Casual register Survival orientation 8/15/201521

22. Cont. Negative, polarized thinking Belief in fate- no options or choices-one is fated Time relates to the present 8/15/201522

23. IMPACT ON CARE Think about the following issues in dealing with clients/ patients: Cooperation Competition Authority Deception How do these characteristics surface when working with individuals living in the Culture of Poverty? 8/15/201523

24. 8/15/201524 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.

25. 8/15/201525 An understanding of poverty will decease the anger, frustration and prejudice the we may feel when working with individuals with limited resources.

26. STEPS WE CAN TAKE Recognizing our biases Seeking to understand Increasing the trust factor Get to know the human being 8/15/201526

27. 8/15/201527 “When we can no longer change a situation, we are challenged to change ourselves.” - Viktor Frankl