Student nurses need better understanding of people living in poverty

Nursing students need a broader understanding of how social conditions influence the health of people living in poverty if they are to provide sensitive care, and more importantly, work toward community and policy solutions to poverty, says a new study done in part by the University of Alberta.

A survey of student nurses, conducted by the University of Alberta along with McMaster University and Dalhousie University, showed that while most of the students understand that poverty decreases access to resources and conditions that facilitate good health, they also believe they have limited exposure to poverty through their academic courses. The results are published in the Journal of Advanced Nursing.

While the students are taught in class about the issues surrounding poverty, they sometimes have difficulty grasping the dynamics and complexities of it, said Dr. Linda Reutter, a professor of nursing at the University of Alberta, and one of the lead authors on the study.

"Many people do not really understand the societal factors that contribute to the causes and effects of poverty. It is not uncommon to encounter negative attitudes toward the poor, even in our classes. There are a lot of myths and stereotypes. Nurses--and other health care workers--may blame the poor for their situations. They may say that poor people do not spend their money wisely, when they don't understand that some behaviours, such as smoking for example, might be coping strategies to manage the stress experienced by the poor in their daily lives," Dr. Reutter said.

Misconceptions about poverty that lead to insensitive care may prevent the poor from seeking the help they require from front-line health-care workers, according to Reutter and her fellow researchers. "They don't feel the worker really understands where they are coming from."

The 59-question survey of 740 basic baccalaureate nursing students was conducted in the three universities in 2000. The results showed, among other things, that only 13 per cent of the students had ever lived in a poor neighborhood and only 7 per cent had ever received social assistance. When asked about their main source of information on poverty, about one-third identified the news media, with 18 per cent citing academic courses. The students felt they had limited exposure to poverty through their coursework, and believed there should be a greater emphasis on exploring its influence on health, particularly the societal factors that contribute to poverty and its negative influence on health.

The survey also revealed that those students who had more positive attitudes toward the poor were more likely to believe that societal, rather than individual factors accounted for the health effects of poverty. Coursework related to poverty also contributed.

The study recommends that nursing students should have opportunities not only to work with those living in poverty, but also to take part in initiatives at the community and policy levels.

"They should have some practical placements where they are working with people who are trying to do something about poverty at a societal level. They should be exposed to organizations who advocate for public policy that is more likely to decrease poverty and its negative effects on health," Reutter said.

Currently, 14 per cent of Canadians live in poverty, with much higher rates for groups like single parent mothers, older women, immigrants and Aboriginals. In addition, poverty is now considered by the World Health Organization to be the most influential determinant of health, the study noted.