A Q methodology study of perceptions of poverty among midwestern nursing students

doi:10.1016/j.nedt.2014.10.017

Nurse Education Today

Volume 35, Issue 2, February 2015, Pages 328-332

https://doi.org/10.1016/j.nedt.2014.10.017 Get rights and content

Summary

Objectives

Providing patient-centered care involves understanding how social factors, including poverty, affect health outcomes. The purpose of this study was to explore nursing students' beliefs surrounding the poor.

Design

A Q methodology design was used to discover patterns of perceptions towards those living in poverty.

Setting

The study took place on two campuses of a large public, university in the Midwestern United States.

Participants

The purposeful sample of 23 Q participants was drawn from students enrolled in the second, third, and final year of study in a baccalaureate nursing program.

Methods

Participants rank-ordered their level of agreement with a set of 30 statements regarding poverty. Data were analyzed by a three-step process that included correlating participant profiles, performing factor analysis, and generating factor scores. A factor array and narrative were used to explain the findings.

Results

Three viewpoints were identified: Judges who tended to feel that poverty was linked to individual behavior; Allies who mostly saw societal reasons for poverty and felt a strong need to assist the poor, and Observers who did not blame individual for their circumstances, but were not as compelled to champion their cause.

Conclusions

Given these different perspectives, educators may need to use variety of teaching approaches to help students achieve patient-centered care competencies with their poorest patients.

Introduction

Nurse educators strive to teach quality and safety competencies in patient and people-centered care during pre-licensure education (Cronenwett et al., 2007, World Health Organization, 2007). These quality and safety competencies involve recognizing personal attitudes about working with persons from different social backgrounds, seeking to learn from them, and being willing to support patients with differing values (Cronenwett et al., 2007). Poverty may be viewed as one of these social backgrounds. To provide effective care, students must be sensitive to the causes and ramifications of poverty (Sword et al., 2004). The problem is that direct exposure to poverty among nursing students in affluent countries may be limited leading to unfavorable attitudes towards the poor that could affect care quality (DeLashmutt and Rankin, 2005, Reutter et al., 2004). This manuscript describes a project to explore beliefs surrounding the poor in a group of nursing students in the United States. The findings suggest that a variety of teaching and learning strategies may be needed in nursing curricula to address diverse poverty-related student attitudes.

Section snippets

Background

Atherton et al. (1993) suggested that individuals adopt an overall positive or negative attitude towards the poor, but others believe that attitudes surrounding poverty and its causes are multi-factorial (Feagin, 1972, Feagin, 1975, Reutter et al., 2004, Sword et al., 2004, Reif and Melich, 1993, Yun and Weaver, 2010). Feagin was one of the first to suggest that people tended to believe in an individualistic, structural, or fatalistic explanation for why there were poor in wealthy nations. The

Methods

First created by Stephenson (1935) and made popular by Brown (1980), Q methodology is a type of mixed-method research that uses an alternative approach to factor analysis to study subjectivity. In this method participants, or Q participants, become the variables. Q studies involve analyzing a rank-ordering of participant's level agreement with a set of subjective statements surrounding a given topic known as the Q sort. Using relatively small sample sizes, statistical principles are then

Results

Sorting sheets were returned by 23 students with a mean age of 22.17 years (range 19–27 years). All participants were Caucasian. Nineteen participants were female and four were males. Most reported a marital status of being single (N = 21). Participants in this study included 6 students in their second year of study, 10 in their third year, and 7 in the last year.

Initial factor analysis revealed four factors with eigenvalues greater than one. Following varimax rotation, three factors were retained

Discussion

The major Canadian study on perceptions toward poverty among BSN students is now over 10 years old. A decade later, our study reinforces the relevance of Sword and Reutter's work. We found three patterns of attitudes among the nursing students enrolled at our university that represent a blending of those previously cited in the literature. Judges may be viewed as having what others have labeled as attitudes that explain poverty in terms of individual or personal deficiency with behavioral issues

Conclusion

Despite the limitations, our study has implications for nursing education and helps provide direction for future research. Educators may need to use a variety of teaching approaches to help students with different perspectives achieve patient-centered care competencies with their poorest patients. More research is needed to help identify negative perceptions toward poverty among nursing students and to find the most effective methods to change those attitudes. Research is also needed to see if

Acknowledgments

This study received no external funding. The authors claim no conflicts of interest.

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A Q methodology study of perceptions of poverty among midwestern nursing students

Summary

Objectives

Design

Setting

Participants

Methods

Results

Conclusions

Introduction

Section snippets

Background

Methods

Results

Discussion

Conclusion

Acknowledgments

Nurs. Outlook

Nurse Educ. Today

Measuring attitudes toward poverty: a new scale

Soc. Work. Res. Abstr.

Understanding international graduate students' acculturation using Q methodology

J. Coll. Stud. Dev.

Political Subjectivity: Application of Q Methodology in Political Science

Closing the gap in a generation: health equity through action on the social determinants of health

Final Report of the Commission on Social Determinants of Health

Exploring attitudes: the case for Q methodology

Health Educ. Res.

A different kind of clinical experience: poverty up close and personal

Nurse Educ.

Poverty: we still believe that God helps those who help themselves

Psychol. Today

Subordinating the Poor: Welfare and the American Beliefs

Popular explanations of poverty: a critical discussion of empirical research

J. Soc. Policy