social determinants of health nursing

Reducing health inequity in the United States is a social mandate for nursing in the 21st century. Executive summary. Didactic content in both the classroom and simulation can provide opportunities for students to master interviewing and inquiry skills that can better elicit information regarding SDOH. American Association of Colleges of Nursing. (2008). What did the person do or fail to do to stay healthy? Nurses, on the frontlines of healthcare, are uniquely positioned to assess for social determinants of health and positively address health equity. Rooks, R., & Rael, C. (2013). Institute of Medicine. While not created solely for nursing education, nurses are a target population for the LEND program. WSNA provides representation, education and resources that allow nurses to reach their full professional potential and focus on caring for patients. Academic Medicine, 93(2), 159-162. doi:10.1097/ACM.0000000000002054, Stanhope, V., Tennille, J., Bohrman, C., & Hamovitch, E. (2016). Empathic inquiry: A patient-centered approach to social determinants of health screening. Educate your colleagues about how social factors lead to health disparities. The ANA Code of Ethics (2015) affirms this need in Provision 9, calling for nursing education programs to “anchor students in nursing’s professional responsibility to address unjust systems and structures, modeling the profession’s commitment to social justice and health through content, clinical and field experiences, and critical thought” (p.36). The future vision of simulation in health care. Introduction. (2018). Reconsideration of both curricular content and traditional acute care clinical experiences is necessary to prepare new nurses for future practice (Murray, 2017). doi:10.17226/21923. (2006). To this end, we offer several recommendations. The guidelines set forth by American Association of Colleges of Nursing (AACN) Essentials documents call for the inclusion of social justice concepts across bachelor’s, master’s, and doctoral programs in nursing (2006, 2008, 2011). Social determinants of health (SDoH) is a relatively new term in health care. By the Washington Nursing Action Coalition. (2016). Retrieved from https://www.nursefamilypartnership.org/, Oregon Primary Care Association. Additionally, the skills of collaboration, teamwork, leadership, and diversity of thoughts are required to plan, intervene, and evaluate interventions that address these complex issues (Benfer, Gold, & Schweitzer, 2012). A key factor that distinguishes service learning from other similar experiences is the use of reflective exercises that connect specific course objectives to the service experience (Rooks & Rael, 2013). This perspective moves beyond gaining knowledge and encourages students to understand, reflect, analyze, and apply content to potential future experiences and encounters. Nursing students need opportunities to connect didactic material with meaningful clinical experiences in a variety of settings. But to more success­fully reform the health care system, it’s crucial to under­stand – and artic­u­late to others – what are the most impor­tant contrib­u­tors to a person’s health, why some people are healthier than others, and how we can ensure health equity for every­body and address health disparities. Nursing in 3D: Workforce diversity, health disparities, and social determinants of health. Washington, DC: National Academy of Medicine. Social determinants of health (SDoH) is a relatively new term in health care. Often referred to as “social determinants of health” (SDOH), these factors can drive as much as 80 percent of health outcomes. American Association of Colleges of Nursing. National Advisory Council on Nurse Education and Practice. A diverse workforce is a precursor to reducing health disparities and achieving health equity (LaViest & Pierre, 2014; Williams, et al., 2014). Washington, DC: The National Academies Press. Solely integrating SDOH into the didactic components of a curriculum has not been effective in influencing future engagement and advocacy among students in the health professions. These cir-cumstances are shaped by the distribution of money, power and resources at global, national and local lev-els” [1]. A framework for educating health professionals to address the social determinants of health. Integration of Social Determinants of Health in Nursing Education, Practice, and Research 16th Report of the National Advisory Council on Nurse Education and Practice to the Secretary of Health and Human Services and the U.S. Congress These threads can be easily tied to those related to SDOH. Nurse educators must consider innovative opportunities for students at all levels to develop a deep understanding of the issues that these groups face. There is no doubt that minority nurses experience slights which are related to race from unconscious bias which permeates our culture. For example, Sabato et al. Marleen Thornton, PhD, RN 23, No. As a nurse, you have likely seen the same person get readmitted to your facility over and over again, or perhaps you have wondered what led to a certain patient’s illness. Journal of Christian Nursing, 34(1), 48-51. Service learning is a structured experience that combines community-based service with specific learning objectives, preparation, and reflection (Schmidt & Brown, 2016). Faculty development is essential for those interested in integrating SDOH into nursing programs through the various strategies discussed. (2013). Reducing health inequity is a clear social mandate for nursing in the 21st century, and will require nursing care that is more acutely focused on the SDOH. Dr. Marleen Thornton is an Associate Professor and serves as the RN to BSN Online Program Director in the School of Nursing at Notre Dame of Maryland University. Catalysts for change: Harnessing the power of nurses to build population health in the 21st century. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels” . Service learning in undergraduate nursing education: Strategies to facilitate meaningful reflection. Integrating the 3Ds- Social determinants, health disparities, and health-care workforce diversity. Throughout her professional career, Dr. Persaud has focused on health promotion, vulnerable populations, and engaged learning. Closing the gap in a generation. (2016). Community and public health nursing courses have been the traditional place for content related to SDOH within undergraduate nursing curricula. However, there will continue to be a need for nurses in the acute care environment who understand and assess for SDOH. Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life. doi:10.1177/00333549141291S207, World Health Organization. For example, the Community Action Poverty Simulation by the Missouri Association for Community Action (2012) has produced significant changes in knowledge and attitudes about poverty among undergraduate students (Reid & Evanson, 2016). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK395983/pdf/Bookshelf_NBK395983.pdf. This simulation provides participants with the opportunity to address food, shelter, and other basic needs while playing the role of families living with low income, coping with real-life scenarios, and interacting with community resources. Under­standing that the context of people’s lives deter­mines their health proves that blaming individ­uals for having poor health or crediting them for good health won’t move our needle on outcomes on the national scale. Children growing up in more deprived areas often suffer disadvantages throughout their lives, from educational attainment through to employment prospects, which in turn affe… Faculty should consider these settings for all nursing courses, even those that have traditionally used the acute care setting to provide clinical education. The individual patient circumstances that are gaining greater awareness in practice due to their effects on “health disparities, health outcomes, and overall quality of health” are called social determinants of health (SDOH) (Persaud, 2018). Gaba, D. (2004). Overcoming these biases is necessary to properly address SDOH. Service learning is one of the most common educational approaches to address SDOH. Key Words: Social determinants of health, nursing education, diversity, interprofessional education, health equity, simulation, service learning. (2014). These students also showed a significant increase in their belief that they can have influence in the community. Asking your patients the right questions about some social factors that affect their lives can shape more effec­tive inter­ven­tions. (2016). Sabita Persaud, PhD, RN, APHN-BC. How might they be applied to our everyday lived experiences? Schmidt, N., & Brown, J. In fact, a decrease in these areas has been noted in some cases (Rooks & Rael, 2013; Villanueva, Hovinga, & Cass, 2011). Seattle, WA 98188. Integrating social determinants of health into graduate medical education: A call for action. Working with agencies that utilize the Nurse Family Partnership (2018), Healthy Families America Program, (2015) or similar programs, allows students to examine and learn first-hand about these content areas in an environment where both positive and negative outcomes can be witnessed. About social determinants of health. These connections can further assist students in their understanding of health policy. Literature that supports the abilities of practicing registered nurses to address SDOH is very limited. The ability to address specific SDOH that may impact patients and then connect them with specified services has the potential to reduce healthcare costs (Pruitt, Emechebe, Quast, Pamme, & Kristopher, 2018). She is currently engaged in projects focused on the social determinants of health and the related role of the nursing profession. Silver Spring, MD: American Nurses Association. The essentials of doctoral education for advanced nursing practice. Partnerships between professions vested in health equity can address the needs of the community while enhancing the student learning experience. Social determinants of health result in health inequities that often require a social justice perspective. Geneva: World Health Organization. Healthy People 2030 uses a place-based framework that outlines five key areas of SDOH: Healthcare Access and Quality Journal of the Scholarship of Teaching and Learning, 13(2), 84-100. Dr. Thornton obtained a Bachelor of Science in Nursing and Master of Science in Nursing from Kent State University in Kent, OH, and a PhD in Nursing from the University of Colorado in Denver. Create intentional programs of service learning. Child development is influenced by various aspects starting from birth, biology, genetic characteristics, gender, culture and family values. Social determinants of health raise questions of social justice for nurses who are engaged with families. Nurses are well positioned to help their facil­i­ties meet the Triple Aim – reduce costs, improve outcomes and improve patient experi­ence of care. We know that a person’s level of educa­tion, employ­ment and income is the single-biggest predictor of their health status – more so than healthy behav­iors, access to and utiliza­tion of clinical care, and their physical environment. Increasing awareness that social determinants have a profound influence on health care outcomes and costs has motivated a slew of policy changes and recommendations intended to … Nursing, with its holistic model of health care, is positioned to be a leader in improving health by linking SDH to outcomes through analysis and action. 1). Recommendations from the Macy Foundation Conference on preparing registered nurses for enhanced roles in primary care. The overall health of a community is determined by the health of its members. Accelerated RN-to-BSN service-learning program serves the vulnerable. Social Determinants of Health In all countries, it is well-established that poorer people have substantially shorter life expectancies and more illnesses than the rich — inequalities that cannot be explained by differences in health care or by personal health behaviours. Transformative changes are needed in nursing education to prepare nurses to adequately address SDOH and improve health equity. Sabato, E., Owens, J., Mauro, A., Findley, P, Lamba, S., & Fenesy, K. (2018). Let’s help others stop thinking of health as something we get in a hospital or clinic, but instead as something that starts in our homes, in our schools and workplaces, and in our playgrounds and parks. She received a Bachelor of Science in Nursing and Master of Science in Nursing – Community Health from the University of Maryland at Baltimore, and a PhD in Health Services from Walden University. Great childhoods begin at home. Give an example of the steps a nurse can take to break the link within the communicable disease chain. Each team member applied discipline-specific knowledge as the group analyzed and managed the cases. Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. Program leaders must commit resources needed for both faculty and student development. Paper presented at the Sigma Nursing Education Research Conference, Washington, DC. Positively transforming the lives of babies, mothers and families. Exploring the benefits of community-based research in sociology of sexualities course. Retrieved from https://www.healthyfamiliesamerica.org/. (2017). Students self-selected a population based on their geography, personal interest, and goals. You are pointing out a very important and interesting effect of our “blindedness” to racial injustices toward our minority nurse colleagues. Do they have access to: As the advocate for your patient, you have the oppor­tu­nity to be their link to better health. Simulation can provide students with first-hand experiences that increase awareness and support the need to reconsider individual biases. Other specific examples of how SDOH can be integrated throughout nursing curricula include: the use of interprofessional education and collaboration; the use of simulation to improve assessment skills and communication related to the SDOH; education about motivational interviewing/empathic inquiry; curricular content on advocacy and policy closely related to improving SDOH and health equity; and service learning. Access to conditions that permit health is shaped by the circumstances in which people are born, grow up, live, work and age, and an array of political, economic, social, cultural and environmental conditions and forces. Simulation Journal of Professional Nursing, 32(2), 130-140. doi:10.1016/j.profnurs.2015.10.002. (2014). Each of these is briefly reviewed below. Empathic inquiry requires listening without judgement and understanding the importance of the environment in which the inquiry takes place. Developing interprofessional simulation in the undergraduate setting: Experience with five different professional groups. Expand clinical education experiences outside of the acute care setting. (2015). There is a social gradient across many of these determinants that contribute to health with poorer individuals experiencing worse health outcomes than people who are better off. Service learning is one of the most common educational approaches to address SDOH (National Academy of Sciences, Engineering, & Medicine, 2016). Social determinants of health result in health inequities that often require a social justice perspective. Preparing nursing for new roles in population health management. The foundations of professional practice and values in nursing, including altruism, autonomy, human dignity, integrity, and social justice, should be addressed not just at the beginning or end of program coursework but as threads throughout curricula (AACN, 2008). Barnes, M. (2017). Do they need board members or committee members? LaViest, T., & Pierre, G. (2014). Expenditure reductions associated with social service referral program. States have a significant opportunity to cover some nonmedical servic… Social determinants of health (SDOH) are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes. SDH includes such factors as socioeconomic status, environment (including air and water quality), food insecurity and food safety, education, employment, social networks, homelessness, and racism. The Washington State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Retrieved from https://www.bls.gov/oes/current/oes291141.htm#nat, Villanueva, A. M., Hovinga, M. E., & Cass, J. L. (2011). Empathic inquiry is an approach to conducting SDOH interviewing that is based in motivational interviewing and trauma-informed care. Developing self-efficacy and self-awareness enables community members to improve the overall health of their communities through sustainable actions. (2011). Motivational interviewing encourages participants to explore the reasons for their health and provides structure for collaborative conversations related to health behavior change (Stanhope, Tennille, Bohrman, & Hamovitch, 2016). Interprofessional Education and Collaboration It is important to distinguish service learning from volunteerism and clinical experiences. Appiah-Brempong, E., Okyere, P., Cross, R., & Adjei, R.O. Josiah Macy Jr. Foundation. Bryant-Moore, K., Bachelder, A., Rainer, L., Hayman, K., Bessette, A., & Williams, C. (2018). Retrieved from http://www.communityaction.org/povertysimulations/, Murray, T. (2017). Solely integrating SDOH into the didactic components of a curriculum has not been effective in influencing future engagement and advocacy among students in the health professions. Journal of Public Health Management & Practice, 17, 369-372. Social determinants of health affect factors that are related to health outcomes. Rockville, MD: Author. The broad social and economic circumstances that together influence health throughout the life course are known as the ‘social determinants of health’. These experiences can range from screening clients in a health clinic for the homeless to health education in elementary schools. What are the social determinants of health? Maternal and Child Health Journal, (18)2, 431-442. doi:10.1007/s10995-013-1283-0. (2011). These circum­stances are shaped by the distri­b­u­tion of money, power and … Open your eyes to poverty. Gather Community Data With a Social Determinants of Health Questionnaire. Strong communities are necessary to address SDOH through social action and advocacy (Appiah-Brempong et al., 2013). Integrating social determinants of health into dental curricula: An interprofessional approach. American Nurses Association. Following an extensive pilot, six content areas with corresponding content themes, in addition to instructional strategies, were developed to guide curriculum integration (Edwards, Towle, & Levitz, 2014). The workshops focused on introducing service learning concepts, gaining knowledge, developing compassion for others, and reflecting on the experiences. 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