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E-Zine Archives
Poverty, Powerlessness and Healthcare
Posted on February 5, 2008 | Permalink
As a nurse, you may work in a clinic or hospital setting which largely serves people who live in or close to the poverty line; similar to treating people who are more affluent, it has its unique rewards and challenges. In order to work most effectively and empathically with this population, it is important to be aware of the issues that influence this population’s beliefs and their actions, including their health. People who are at the bottom of the economic ladder often suffer from very low self-esteem and have experienced little control over their life; that feeling of powerlessness has influenced their choices. When a person experiences little sense of control over their life, they are less likely to feel that taking responsibility makes a difference; it is as though they are saying, ‘life happens to me’. Obviously, this stance can be quite frustrating for a healthcare provider because someone who has experiences so little control over their life doesn’t understand how their actions can actually influence their health in both positive and negative ways.
An approach for a nurse to consider when treating people with low self-esteem (including feelings of overwhelming powerlessness) is to engage the patient with taking small, manageable steps to enlist a behavior change; for example, if a patient has to modify their diet, it is important to start the discussion with the question, "based on our conversation, what is one thing that you would be willing to do—one change that you can make in your diet?" If the patient is unable to identify a specific step (change), you may need to take a more active role with a patient. An initial dialogue can include, "let’s talk about what you usually like to eat for dinner?" If the patient reels off a menu with a litany of foods that are on the ‘avoid list’, you may want to make a suggestion that could motivate a response from the patient; an example of this approach might be, "instead of putting butter and salt on your fries, would you be willing to have a baked potato without salt?" The patient then has a frame of reference in which to make subsequent choices. This example represents a starting point: helping the patient to negotiate what they could imagine giving up along with discussing what they could add to their diet opens the door to the notion of options—options that a patient may have never considered. And when a patient is exposed to options, doors to other possibilities open in their life; this process could begin to shift the notion of powerlessness to empowerment, a terrific outcome for a patient who needs to change their behavior in some significant ways. While it is not unusual, at times, to feel impatient, frustrated and perhaps prejudiced towards a patient who experiences themselves as powerless it is not a reason to give up on a patient. Similar to other situations a nurse is faced with, the need to employ an effective strategy may be the key to success. It is definitely worth a try!
E-Zine Archives
- Medication Mix-Up: A Case Study (August 6, 2007)
- Always, always check out your assumptions about a patient’s well-being! (August 30, 2007)
- Communication with Patients: What a New Nurse Needs to Know! (October 10, 2007)
- Communication Skills: Leap and Bounce© (November 12, 2007)
- Poverty, Powerlessness and Healthcare (February 5, 2008)
- An Unresolved Conflict affects the Team (April 26, 2008)
- The Saga of my Fractured Meta-Carpal (August 9, 2008)
- The Nursing Shortage: Focus of PBS program, NOW (October 28, 2008)
- Is Nursing Really Recession-Proof? (February 21, 2009)
- Maintaining Empathy and Boundaries for Your Patients and Yourself (April 6, 2009)
- How Well Prepared are You for the Challenges Facing Nurses in the 21st Century? (October 27, 2009)