Poverty and healthcare: Lessons for care of the impoverished

Healthcare reform has changed the landscape of healthcare as thousands of insurance naïve patients enter the market, many of whom come from diverse and impoverished backgrounds.  Nurse practitioners are at the forefront of providing care to these vulnerable patients. Since many of these persons have not previously accessed the healthcare system, healthcare professionals and students have had little experience with this population or its unique world view. Just as Ruby Payne’s landmark work enlightened primary educators with the special needs of students living in poverty, knowledge of the effect of poverty on healthcare will be required to provide effective care to this new wave of impoverished patients. It is imperative that nurse educators prepare students adequately for this special population.

A Midwestern health sciences college established a free clinic in partnership with the local Salvation Army to provide a service-learning opportunity for nurse practitioner students. Students are required to provide 20 hours of service at the nurse-run clinic while supervised by licensed faculty.  In spite of the Affordable Care Act, patients continue to fall through the cracks or delay signing up for insurance.

Lessons learned from the free clinic include the present orientation of persons living in poverty and its effect on choices regarding healthcare. Patients’ less robust language has a greater effect on comprehension than anticipated however, results of patient surveys show that patient education can be very effective. Student benefits from service-learning also included statistically significant increases in intent to serve the community (0.025), cultural competence (.0001, .0048, .0064), and knowledge of barriers to healthcare experienced by the impoverished (<.0001).

Nurse practitioners are the key to provision of quality, low cost care in the future. Service- learning provides an evidence-based method to assure nurse practitioner students have the knowledge and experience to be leaders in advocating for patients living in poverty.