social determinants of health nursing

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. These simulation experiences can help nursing students identify life circumstances and SDOH that influence overall health. Washington, DC: The National Academies Press. Nurse educators must consider innovative opportunities for students at all levels to develop a deep understanding of the issues that these groups face. Simulation can provide students with first-hand experiences that increase awareness and support the need to reconsider individual biases. Educate your colleagues about how social factors lead to health disparities. 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. (2016). Social Work in Public Health, 31(6), 474-480. doi:10.1080/19371918.2016.1160338, United States Department of Labor, Bureau of Labor Statistics. The SDOH have downstream health impacts that not only affect patient well-being and health equity, but healthcare spending as well. You are pointing out a very important and interesting effect of our “blindedness” to racial injustices toward our minority nurse colleagues. The World Health Organization ([WHO], 2018) defines the SDOH as, “the conditions in which people are born, grow, live, work and age that impact their health” (para. Marleen Thornton, PhD, RN 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. This article was submitted by leaders of Washington Nursing Action Coalition’s Leader­ship workgroup: Sofia Aragon, JD, BSN, RN, Washington Center for Nursing Execu­tive Director and Washington Nursing Action Coali­tion (WNAC) Co-Lead, Katie Eilers, MPH, MSN, RN, WNAC Leader­ship workgroup co-lead, Dorene Hersh, RN, MN, WNAC Leader­ship workgroup co-lead, Sarah Wicken­hagen, DNP, FNP, ARNP, WNAC Leader­ship workgroup co-lead, Kathy Mertens, MN, MPH, RN, WNAC Leader­ship workgroup member, Washington State Nurses Association To this end, we offer several recommendations. Social determinants of health raise questions of social justice for nurses who are engaged with families. Recommendations to Incorporate SDOH in Nursing Curricula. (2013). Empathic inquiry is an approach to conducting SDOH interviewing that is based in motivational interviewing and trauma-informed care. Nurse educators using poverty simulations must be careful not to perpetuate stereotypes or assumptions about poverty. However, it has been noted that one service learning course may not be enough to observe a significant change in these areas. This call has prompted more nursing programs to thread this information throughout curricula, as opposed to confining SDOH concepts to select coursework, and thus may increase opportunities for broader study of this important content. These conditions are shaped by the amount of money, power, and resources that people have, all of which are influenced by policy choices. Nurse educators using poverty simulations must be careful not to perpetuate stereotypes or assumptions about poverty. (2018). Washington, DC: American Association of Colleges of Nursing. 1. Positively transforming the lives of babies, mothers and families. The workshops focused on introducing service learning concepts, gaining knowledge, developing compassion for others, and reflecting on the experiences. It is important for faculty to consider multiple ways of reflection, such as journaling, artwork, storytelling, and portfolios. Academic Medicine, 93(2), 159-162. doi:10.1097/ACM.0000000000002054, Stanhope, V., Tennille, J., Bohrman, C., & Hamovitch, E. (2016). Using simulation to teach about poverty in nursing education: A review of available tools. Influence of nurse leaders at all levels on the development and implementation of health policy must address SDOH to improve health equity by specifically addressing upstream, or larger systematic, factors. 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 … 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. Silver Spring, MD: American Nurses Association. Let’s ensure all Ameri­cans are as healthy as they can be. Thank you for your thoughtful and enlightening letter. Limiting content on the SDOH to community/public health and/or elective courses further encourages a divide between where it is and is not appropriate to assess or address SDOH. Expand clinical education experiences outside of the acute care setting. Acknowl­edging that health starts in our homes, schools and commu­ni­ties is the first step toward building a culture of health. The situation is similar throughout other health professions. Each of these is briefly reviewed below. Incorporating life course theory and social determinants of health into the LEND curriculum. (2016). Literature that supports the abilities of practicing registered nurses to address SDOH is very limited. To excel in population health management, an organization must understand how individual characteristics and contextual factors, external to the care delivery process, impact a population’s health. Social Justice and Advocacy An effective curriculum should include multiple SDOH experiences, community engagement, and student reflection. (2012). Retrieved from https://www.bls.gov/oes/current/oes291141.htm#nat, Villanueva, A. M., Hovinga, M. E., & Cass, J. L. (2011). New York, NY: Author. Are there agencies that are working to tackle broad social issues? 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. Rockville, MD: Author. Exploring the benefits of community-based research in sociology of sexualities course. Providing clinical experiences in nursing education related to this content requires moving some clinical experiences from the acute care setting to work with organizations that provide care for pregnant mothers and young families. (2012). This perspective moves beyond gaining knowledge and encourages students to understand, reflect, analyze, and apply content to potential future experiences and encounters. The social determinants of health—defined by the World Health Organization as the conditions in which people are born, grow, live, work and age—can influence as much as 80% of your health outcomes.These factors are also a driving force behind many health disparities that are occurring today worldwide. Interprofessional Education and Collaboration Recommendations from the Macy Foundation Conference on preparing registered nurses for enhanced roles in primary care. Give an example of the steps a nurse can take to break the link within the communicable disease chain. The Institute of Medicine (2010) has highlighted the benefits of interprofessional education (IPE) and called for its use to improve healthcare delivery and health outcomes. Children growing up in more deprived areas often suffer disadvantages throughout their lives, from educational attainment through to employment prospects, which in turn affe… How much education a persons obtains 3. Expenditure reductions associated with social service referral program. (2018). Working directly with vulnerable and marginalized populations most affected by SDOH is an essential component of nursing education (AACN, 2008). Key Words: Social determinants of health, nursing education, diversity, interprofessional education, health equity, simulation, service learning. Effects of service-learning on graduate nursing students: Care and advocacy for the impoverished. 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. She teaches across the undergraduate and graduate nursing curricula, focusing on healthy aging and nursing theory. Schmidt, S., George, M., & Bussey-Jones, J. We know that condi­tions in which people are born, grow, live, work and age, known as the social deter­mi­nants of health, combine together to affect the health of individ­uals and communities. Service learning is based on collaboration between the academic institution and the community partner. Journal of Professional Nursing, 32(2), 130-140. doi:10.1016/j.profnurs.2015.10.002. What did the person do or fail to do to stay healthy? The majority of students related social conditions to lifestyle choices, rather than circumstances, during the initial exploration early in their program. Code of ethics for nurses with interpretive statements. Schmidt, N., & Brown, J. For more than 110 years, WSNA has championed issues that support nurses, advance professional standards and improve the health of individuals and families in Washington. Currently, Dr. Persaud is involved in research projects focusing on nurses’ knowledge, attitudes, and behaviors related to the social determinants of health. Catalysts for change: Harnessing the power of nurses to build population health in the 21st century. These include, but are not limited to, an understanding of the more complex and less obvious drivers of health such as neighborhood safety, discrimination based on sexual orientation and gender identity, and job security. Look beyond your patients. Can you connect your patient to a service they need? For example, medical students who learned about SDOH from a didactic (i.e., non-experiential) approach have shown an increase in negative attitudes toward the medically underserved as they progress through a program (Schmidt, George, & Bussey-Jones, 2016). Nursing education leaders at all levels must consider innovative ways to cultivate diverse graduates who sincerely desire to address SDOH. The levels of health inequity that currently exist within the United States will not be relieved by one healthcare profession alone, yet nursing holds the greatest capacity to address this major challenge of the 21st century. Examples of SDOH include: Safe housing, transportation, and neighborhoods; Racism, discrimination, and violence; Education, job opportunities, and income; Access to nutritious foods and physical activity opportunities; Polluted air and water The World Health Organization and others have defined and identified multiple social determinants of health (SDOH) that may negatively impact patient health and contribute to health inequity. For example, Sabato et al. Graduate level program content has varied depending on the focus of the program. 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. Income is one of the most important determinants of health and several tools exist to simulate poverty conditions and enhance student understanding of and attitudes toward working with the poor and life in poverty (Reid & Evanson, 2016). Population Health Management (ahead of print). Marleen Thornton, PhD, RN Journal of Interprofessional Care, 26(5), 362-369. doi:10.3109/13561820.2012.685993, Cheshire, M., Montgomery, M., & Johnson, P. (2017). Commit to the integration of content related to SDOH throughout curricula. This method of inquiry emphasizes engaging, empathizing, supporting, summarizing/action planning, and collaborating with the team. Focus on improving workforce, student, and faculty diversity. American Nurses Association. ... reflection offers an opportunity for both students and faculty to explore the difficult issues related to SDOH... Reasons for this decrease included unrealistic expectations of the student and community-based organization (CBO); incompatible interest between the student and CBO; lack of student understanding about the CBO; and lack of attention to reflection. Introduction. Registered nurses: Partners in transforming primary care. Social determinants of health determine whether individuals stay healthy or become ill (a narrow definition of health). doi:10.1177/00333549141291S207, World Health Organization. Resources within your text covering international/global health… Health behaviour change: Advancing the utility of motivational interviewing (MI) to health promotion. Occupational Employment and Wages, May 2017. For example, an interprofessional education opportunity to complete a community needs assessment can be provided for nursing and education students, or nursing and law students. Social justice is built on the concept that there is a need for fair and just relationships between individuals and society. What are the social determinants of health? While motivational interviewing and empathic inquiry are seemingly focused on the individual, this is also an important area of health promotion at the community level. Princeton, NJ: Author. American Association of Colleges of Nursing. We also discuss faculty development and diversity as a strategy of impact, and conclude with a call to action and recommendations for nurse educators working to include SDOH in nursing program curricula. These circum­stances are shaped by the distri­b­u­tion of money, power and resources at global, national and local levels. Before a major shift in clinical placements can occur, some consideration must first be paid to the commitment of the organization to address the SDOH, and then to accessibility, safety, and sustainability. The motivational interview strategy is useful to elicit intrinsic motivation for behavior change and strengthen an individual’s own self-efficacy and capacities to change (Appiah-Brempong, Okyere, Cross, & Adjei, 2013). Develop interprofessional education initiatives that encourage collaboration. IPE has been shown to have a profound impact on student knowledge and attitudes on practice issues (Buckley et al., 2012). The social determinants of health (SDoH) are receiving considerable attention globally due to their tremendous influence in shaping health status, quality of life and health outcomes. Discussion Paper, Vital Directions for Health and Health Care Series. 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. During this two-year program, students from both dentistry and nursing participated in a number of activities as they collaboratively worked through case studies. Possessing the skills to offer transformative learning opportunities is essential not only for full time faculty, but also for clinical instructors, mentors, and preceptors. Robert Wood Johnson Foundation. (2016). These connections can further assist students in their understanding of health policy. Screening for SDOH requires skills that allow the nurse to ask potentially sensitive questions, and encourage an interview that is less data driven and more relationship driven. Use of service learning to increase master’s-level nursing students’ understanding of social determinants of health and health disparities. Community and public health nursing courses have been the traditional place for content related to SDOH within undergraduate nursing curricula. Participants demonstrated an overall increase in the perceived value of interprofessional teamwork as well as ability to engage patients in issues related to SDOH (Sabato et al., 2018). The social determinants of health (SDoH) have emerged as some of the most important factors influencing the health outcomes of individuals and communities worldwide. The essentials of master’s education in nursing. A diverse workforce is a precursor to reducing health disparities and achieving health equity (LaViest & Pierre, 2014; Williams, et al., 2014). 1). 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 future of nursing: Leading change, advancing health. The World Health Organization provided one of the earlier definitions of the social determinants of health: “The conditions in which people are born, grow, live, work and age. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK395983/pdf/Bookshelf_NBK395983.pdf. As health care providers, we know that health starts in our homes, schools, communities, and workplaces, which are heavily influenced by the availability … Though direct engagement with the community, students broadened their understanding of the healthcare needs of the population they will serve (Bryant-Moore et al, 2018). These circumstances are shaped by the distribution of money, power and resources at global, national and local levels” . (2008). (2018). Developing self-efficacy and self-awareness enables community members to improve the overall health of their communities through sustainable actions. These experiences can range from screening clients in a health clinic for the homeless to health education in elementary schools. IPE experiences among health professionals that do not tend to collaborate in actual practice can also be beneficial. These threads can be easily tied to those related to SDOH. Yet on some of the most impor­tant indica­tors, such as life expectancy, we’re not even in the top 20 devel­oped countries. The Washington State Nurses Association is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Table. Journal of Nursing Education, 56(1), 319-3210. doi:10.3928/01484834-20170518-01, National Academy of Sciences, Engineering, and Medicine. 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). National Advisory Council on Nurse Education and Practice. Explain how social determinants of health contribute to the development of disease. Describe the fundamental idea that the communicable disease chain model is designed to represent. 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). Nursing education leaders at all levels must consider innovative ways to cultivate diverse graduates who sincerely desire to address SDOH. Workshops were integrated throughout the course to guide students through the experience and ensure that the outcomes were being addressed. Simulation is utilized as both a teaching strategy and method of evaluation within nursing education. (2010). Online Journal of Rural Nursing & Health Care, 17(1), 73-86. doi: 10.14574/ojrnhc.v17i1.439, DeBonis, R. (2015). She is currently engaged in projects focused on the social determinants of health and the related role of the nursing profession. Nurses are uniquely positioned on the frontlines of healthcare to address SDOH that impact health inequities; therefore, nurse educators must proactively develop curricula to include the use of interprofessional education, teaching new skills, utilizing new teaching methods, and forming new partnerships. Recent calls to better prepare nurses for practice outside the acute care environment provide initial support for an emphasis on the integration of the SDOH in nursing curricula (Josiah Macy Jr. Foundation, 2016; National Advisory Council, 2016). The purpose of this article is to explore social determinants of health and nursing education, including clinical and classroom opportunities. Social determinants of health describe the interaction between social, economic, and environmental factors and how they can influence a person’s health outcomes. Recent calls to better prepare nurses for practice outside the acute care environment provide initial support for an emphasis on the integration of the SDOH in nursing curricula (Josiah Macy Jr. Foundation, 2016; National Advisory Council, 2016). States have a significant opportunity to cover some nonmedical servic… Providing clinical placements outside of the acute care setting in courses other than community/public health can help students see the role of nurses in assessing for and addressing SDOH in various practice settings. Opportunities for curricular integration must focus on how to better educate nurses to understand the connections between SDOH and the challenges patients face. (2016). Journal of Christian Nursing, 34(1), 48-51. Social determinants of health have not traditionally been integrated as a thread throughout most nursing education curricula, and this has prevented nurses from acquiring knowledge necessary to assess and address key drivers of health. Diversity in nursing includes representation from racial/ethnic minority groups, men, people with disabilities, and the educationally and economically disadvantaged. These cir-cumstances are shaped by the distribution of money, power and resources at global, national and local lev-els” [1]. 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. This website connects you to CDC resources for SDOH data, research, tools for action, programs, and policy. Dr. Sabita Persaud is currently the Associate Dean for Graduate Studies at Notre Dame of Maryland University School of Nursing, where she has worked since 2012. Lend your exper­tise! Geneva: World Health Organization. Social determinants of health also determine the extent to which a person possesses the physical, social and personal resources to identify and Social Determinants of Health and Nursing: A Summary of the Issues Collaboration develops interventions that move beyond a single discipline and address SDOH from a higher level. As a nurse, you are solution-oriented, equipped with valuable knowl­edge and able to offer great insight. This mandate affirms the need to prepare nurses to understand the need to address social justice issues in a manner that acknowledges their relationships to health. What are social determinants of health? Most people do not think about health in terms of social factors. Institute of Medicine. Surely we have been overlooking something. How a person develops during the first few years of life (early childhood development) 2. Often referred to as “social determinants of health” (SDOH), these factors can drive as much as 80 percent of health outcomes. Transformative changes are needed in nursing education to prepare nurses to adequately address SDOH and improve health equity. (2016). Additionally, students who participate in service learning are likely to participate in similar activities after they enter practice (Schmidt & Brown, 2016). For example, Siegel, Coleman, and James (2018) recently noted that medical schools provide training related to the SDOH in an irregular and often unintentional manner. 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). Service learning is one of the most common educational approaches to address SDOH (National Academy of Sciences, Engineering, & Medicine, 2016). And advocacy social, economic, and social determinants of health nursing of life in your commu­nity requires careful and. 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