Overview and Summary: Contemporary Perspectives on Poverty

In 2005, Nelson Mandela stated, “Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life” (United Nations, 2018, para. 7). Addressing poverty has been an enduring concern within the nursing profession, dating back to 1893 when nurse Lillian Wald founded the Henry Street Settlement in New York City, using the term 'public health nursing' to underscore the profound impact of poverty on community health (The House on Henry Street, n.d). Today, public health nurses continue to play a pivotal role in all 50 states and United States (U.S.) territories, with a specific focus on poverty-related issues.

There is a contemporary resurgence in recognizing the significance of social determinants of health (SDOH), including poverty, and the imperative to integrate SDOH principles into nursing education. Both the American Association of Colleges of Nursing (AACN, 2021) and the National League of Nursing (NLN, 2019) have reinvigorated efforts to incorporate SDOH into nursing curricula. This OJIN topic reflects this renewed emphasis by featuring six articles dedicated to exploring various facets of poverty.

The introductory articles offer insights into understanding poverty concepts, integrating poverty-related content into nursing curricula, and emphasizing the importance of fostering community and academic partnerships to enhance student learning experiences. Among the highlighted articles, three specifically delve into the impact of poverty on distinct populations: college students, older adults, and an international perspective that explores the challenges faced by refugee nurses seeking integration into Jordan's labor market.

Dr. Martha Y. Kubik delivers a comprehensive analysis of the post-pandemic landscape of poverty in her article "Poverty Post Pandemic, Lapsed Public Policy and Rising Rates: A Call to Action for Nursing." The article begins with an in-depth exploration of poverty measurement in the United States, comparing U.S. census data metrics with global poverty measures. Dr. Kubik not only outlines the conventional U.S. approach, but also introduces alternative measurements, including an international monetary poverty line. Despite some strides in incorporating multidimensional perspectives into U.S. poverty data, the prevailing standard relies on census data. This standard is crucial for federal and state programs that provide assistance to individuals deemed "low income." The article presents current national and global poverty rates, shedding light on the United States' supplemental poverty measure (SPM), established in 2011. A notable section of the article delves into the nuanced experience of poverty, addressing episodic versus chronic poverty, intergenerational poverty, and geographic disparities.

Dr. Kubik then examines the impact of the COVID-19 pandemic on poverty, highlighting the cessation of federal funding for childcare in fall 2023 and the anticipated conclusion of federal school funding in September 2024. The pandemic has also exacerbated issues like affordable housing, food insecurity, healthcare debt, and a shortened life expectancy. Concluding with a compelling "call to action for nursing," Dr. Kubik emphasizes the importance of understanding social determinants of health and advocates for increased community engagement among nursing students, the development of academic-practice partnerships, and outreach to community organizations as collaborative partners for nursing schools and colleges. In addressing the evolving landscape of poverty post-pandemic, Dr. Kubik's article serves as a poignant call for proactive measures in nursing education and practice.

The article, "Recognizing and Responding to Poverty in College Students: What Can Nurses Do?" by Dr. Amber L. Kolesar and colleagues offers a comprehensive exploration of poverty issues among college students, delving into identification, its impact on health and academic performance, and appropriate responses. This article starts by addressing the staggering rise in college tuition, revealing a 9% annual increase over the past two decades at four-year public institutions, resulting in a staggering 179.2% overall rise. While reviewing this article, I remembered that I paid $228 per semester for a bachelor's degree in nursing in the 1970s, versus the current cost of $7,375.76 per semester.

The authors draw attention to the United States Accountability Office (2018) findings that 71% of college students in 2016 were considered non-traditional. Specific groups, such as first-generation students, those with disabilities, and students of color or transgender and non-binary individuals, are more prone to food insecurity, impacting academic performance and sleep quality. The article delves into the concept of "period poverty" and "couch surfing" as additional challenges faced by impoverished students. The authors discuss various university level interventions, with a focus on campus pantries as a common initiative, addressing concerns about student awareness and potential stigma. This article showcases successful programs, including student-led pantries, university gardens, and "basic needs hubs" that support students in obtaining essentials like food and housing.

Highlighting the multifaceted role of nurses, the article also explores their potential as educators, advocates, advanced practice nursing program faculty, and providers. A notable aspect is the authors' suggestion to include statements in course syllabi promoting wellness, providing resources, and reducing the stigma associated with poverty and hunger. The article strongly advocates for integrating the SDOH throughout nursing curricula, emphasizing its importance in addressing the complex challenges faced by college students in poverty. In summary, this article not only sheds light on the pervasive issue of poverty among college students, but also provides valuable insights into effective interventions and the critical role nurses can play to address this pressing concern.

The authors of "Poverty in Older Adulthood: A Health and Social Crisis," Dr. Marleen Thornton and doctoral student Katherine Bowers, offer a comprehensive exploration of the challenges faced by older adults dealing with poverty. According to the U.S. Census Bureau (2023), approximately 17% of the population is aged 65 and older, with 1 in 10 older adults experiencing poverty. The article advocates for the use of the Supplemental Poverty Measure (SPM) as a more accurate reflection of elder poverty, considering factors like inflation and costs specific to the older population. The authors introduce the Elder Index as another measurement that captures financial security for elders, highlighting the reality that Social Security alone is often insufficient for retirement; this affects almost half of U.S. elders who lack additional financial resources such as pensions.

While safety net programs for elders are discussed, the article notes that many elders do not meet federal poverty thresholds, hindering their eligibility for specific benefits. Notably, the authors delve into the experiences of marginalized groups, exploring how poverty differs for women, men, LGBTQIA+, and transgender individuals. The article also addresses the rising cost of aging, including housing and healthcare expenses, challenging the perception that Social Security and Medicare benefits adequately cover these costs.

Ageism is discussed as a significant concern, impacting elders who wish to continue working but face discrimination based on age. Leaving the workforce may result in increased loneliness, as jobs often serve as social outlets. The article emphasizes the health outcomes associated with poverty in older adults, showcasing studies that have illustrated its profound impact. It also explores the intersection of poverty and loneliness, recognizing how financial constraints can hinder elders from participating in social events. Two informative tables offer resources to address poverty and loneliness in older adults and summarize recommendations for nurses in education, practice, research, and policy. Overall, this article sheds light on the multifaceted issues surrounding poverty in older adulthood, providing valuable insights and practical guidance for nursing professionals.

The article "First, Seek to Understand: Deconstructing the Concept of Poverty for Nursing Education," authored by Dr. Rebecca C. Lee and DNP student Misty Bauer aims to equip nurse educators with the necessary tools for discussing and integrating the concept of poverty throughout nursing curricula. The authors provide a thorough exploration of social determinants of health (SDOH), emphasizing the link between SDOH, health outcomes, and the pursuit of health equity. The article delves into the association between poverty and poor maternal health and child outcomes, citing studies that highlight the enduring physical and mental health effects on children who have experienced poverty in their formative years.

Clear identification of the stigma attached to poverty is presented, particularly in the U.S., where societal judgments often unfairly label individuals in poverty as lacking motivation or effort. The article underscores the importance of integrating SDOH into healthcare visits, as healthcare providers may be unaware of their patients' socioeconomic circumstances. The authors provide a comprehensive summary for preparing nursing students to care for individuals, families, and communities in poverty, aligning with the recently revised American Association of Colleges of Nursing Essentials (2021) with an emphasis on fostering community partnerships. Recognizing the nursing profession's roots in community nursing, the article highlights a movement by national level entities to promote education on SDOH and enhance community experiences for nursing students. Proposed educational strategies encompass poverty simulations and community-academic partnerships, offering immersive experiences for students.

Highlighting an exemplar from the University of Cincinnati, the article details the process of building bridges in nursing education. The key takeaway from the article centers on the authors' advocacy to develop competencies in assessment and intervention outcomes impacted by SDOH. They emphasize the essential need for empathy grounded in cultural humility, a crucial aspect for both students and faculty to acquire these skills effectively.

"The Poverty Simulation: A Tool to Experience the Social Determinants of Health" by nurse educators Dr. Tracy Motter, Taryn Burhanna, and Jennifer Metheney, presents a valuable perspective on poverty simulation, a tool I introduced at the University of New Mexico, College of Nursing in 2019 through a Health Resources and Services Administration Advanced Nurses Education Workforce Grant. Despite the challenges posed by the pandemic, we have successfully continued to provide the poverty simulation. This article provides a comprehensive overview of the SDOH and acknowledges the nursing community's call to incorporate this content into nursing curricula. Supported by literature emphasizing the need for experiential training, the authors primarily focus on two available simulations that they considered. Their final choice was justified by its broader coverage, including experiences of children, teens, and older adults, accommodating up to 100 participants. The article includes learning outcomes and details the implementation kit, streamlining the simulation launch.

The authors emphasize the significance of the timeline for the simulation, providing a table as guidance. Having experienced the implementation at my institution, I concur with these authors on the importance of recruiting volunteers to assume service provider roles. Funding volunteers, as we have done, enhances student participation as 'families.' Also critical to the success of the simulation are the pre and post-briefings, ensuring participants understand the gravity of the experience. Acknowledging potential triggers for students who may have personal experiences resembling the simulation, the authors recommend providing an option for students who may need this. The article introduces the use of the Debriefing for Cultural Humility© (Foronda, 2021). Our UNM-CON also involves the community service volunteers in group debriefing (groups of up to 20) led by faculty, with subsequent reports to the entire group.

The authors share four learning outcomes and illustrate how these goals were achieved, incorporating de-identified comments from participating students. The article aptly concludes with the recognition that more formal studies, utilizing valid and reliable tools, are essential. Overall, this article provides valuable insights for educators and practitioners aiming to implement poverty simulation as a means to deepen understanding of the social determinants of health.

"Challenges Faced by Refugee Nurses to Integrate into Jordan’s Labor Market: A Phenomenological Study" by Dr. Rowaida Al-Maaitah and colleagues provides a poignant international perspective on the difficulties encountered by refugee nurses in Jordan, shedding light on the broader challenges faced by refugees worldwide. The authors succinctly outline the general struggles experienced by refugees and delve into the specific hurdles confronted by nurse refugees in Jordan. Highlighting Jordan's status as the second-highest host of refugees per capita, the article addresses the complex challenges associated with refugee status, particularly the socioeconomic barriers preventing many refugee nurses from practicing in Jordan.

To gain insight into the unique challenges faced by these healthcare professionals, the authors conducted a qualitative study. Employing a phenomenological perspective, the study included a sample of 16 refugee health professionals from communities and refugee camps outside of Jordan. Focus group discussions and semi-structured interviews formed the basis of the qualitative data collection. The authors conducted a content analysis using measures typical for qualitative studies that revealed seven emerging themes categorized as issues: legal and financial, working environment, educational, professional, family, physical and mental health, and gender.

The article presents de-identified quotes under each of the seven themes, providing a sobering portrayal of the refugee nurses' experiences. Notably, family-related issues and gender disparities emerged as particularly distressing, with female participants expressing challenges related to longer working hours and increased family responsibilities compared to their male counterparts. The authors emphasize the implications for nursing practice, stressing the importance of promoting awareness regarding the challenges faced by refugee nurses. Additionally, they advocate for creating legal opportunities and informing policy to address the complex issues outlined in the study.

The journal editors invite you to share your response to this OJIN topic addressing Contemporary Perspectives on Poverty either by writing a Letter to the Editor or by submitting a manuscript which will further the discussion of this topic which has been initiated by these introductory articles.

Carolyn Montoya, PhD, RN, PNP-PC, FAANP, FAAN
Email: CJMontoya@salud.unm.edu

Carolyn Montoya is Professor and Interim Dean at the University of New Mexico, College of Nursing in Albuquerque, NM. During her professional journey, Dr. Montoya has consistently championed the requirements of families grappling with poverty. This commitment is evident in her role as a Certified Pediatric Nurse Practitioner, where she provided compassionate care. Additionally, she actively engaged in state and federal committees dedicated to addressing poverty issues. As an educator, she spearheaded the inaugural "Poverty Simulation" at the University of New Mexico College of Nursing, made possible through an HRSA grant. This simulation has since become an annual event, contributing to a greater understanding of poverty-related challenges.