social determinants of health nursing

States have a significant opportunity to cover some nonmedical servic… Barnes (2017) found a significant increase in students’ sense of responsibility to serve the community after integrating service learning into an 8-week online RN-BSN course. The essentials of baccalaureate education for professional nursing practice. Give an example of the steps a nurse can take to break the link within the communicable disease chain. Payers of health care are increasingly incorporating the concepts of social determinants of health into the way they think about reimbursing for health care services and providing incentives for health care delivery organizations, says Risa Lavizzo-Mourey, senior fellow at Penn’s Leonard Davis Institute of Health Economics, population health and health equity … Expand clinical education experiences outside of the acute care setting. Nursing education leaders at all levels must consider innovative ways to cultivate diverse graduates who sincerely desire to address SDOH. Healthy People 2030 uses a place-based framework that outlines five key areas of SDOH: Healthcare Access and Quality Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life. 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. Journal of Nursing Education, 56(1), 319-3210. doi:10.3928/01484834-20170518-01, National Academy of Sciences, Engineering, and Medicine. Simulation can also be used to enhance student understanding of literacy, culture, transportation, availability of food, and access to healthcare. 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 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. Robert Wood Johnson Foundation. Increasing racial/ethnic diversity in nursing to reduce health disparities and achieve health equity. (2014). There will always be a need for nurses in every care setting to understand and assess for SDOH. Yet on some of the most impor­tant indica­tors, such as life expectancy, we’re not even in the top 20 devel­oped countries. How a person develops during the first few years of life (early childhood development) 2. The workshops focused on introducing service learning concepts, gaining knowledge, developing compassion for others, and reflecting on the experiences. Service learning is one of the most common educational approaches to address SDOH. Thank you for your thoughtful and enlightening letter. What are social determinants of health? How might they be applied to our everyday lived experiences? Nursing education leaders at all levels must consider innovative ways to cultivate diverse graduates who sincerely desire to address SDOH. 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. Patients with mental illness or behavioral health issues, for example, might face stigma and eventually opt out of receiving treatment. Policymakers are increasingly recognizing the important role that social and economic factors, such as housing, healthy food, and income play in a “whole person” approach to health care, especially among Medicaid’s low-income enrollees. 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. As practitioners, teachers, and researchers engage in activities with and for others, health can no longer be viewed as a transaction; that is, one does not “give” health care to another individual or family. Master of public health community-based practicum: Students’ and preceptors’ experiences. Bryant-Moore, K., Bachelder, A., Rainer, L., Hayman, K., Bessette, A., & Williams, C. (2018). Going micro and gathering information on the individual patient is great, but going macro and learning more about the community you serve as a whole can help you preemptively prepare for the conditions that most commonly affect those who seek your care. Incorporating clinical experiences at a community-based free clinic to improve nursing students' understanding of rural, medically underserved populations. Partnerships between professions vested in health equity can address the needs of the community while enhancing the student learning experience. Missouri Association for Community Action. 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. (2014). (2012). 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. Program leaders must commit resources needed for both faculty and student development. The essentials of master’s education in nursing. 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). (2017). Social determinants of health (SDoH) is a relatively new term in health care. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK395983/pdf/Bookshelf_NBK395983.pdf. (2011). The majority of students related social conditions to lifestyle choices, rather than circumstances, during the initial exploration early in their program. Learn more about social determinants of health. Outside the hospital walls: Social determinants and population health. “Social determinants of health such as poverty, unequal access to health care, lack of education, stigma, and racism are underlying, contributing factors of health inequities,” the CDC wrote. Recommendations to Incorporate SDOH in Nursing Curricula. The SDOH have downstream health impacts that not only affect patient well-being and health equity, but healthcare spending as well. Public Health Reports, 129 (supplement 2), 9-14. doi:10.1177/00333549141291S204. To create a diverse workforce, a diverse and inclusive faculty is also necessary to serve as role models for students, and mentors with similar experiences (Phillips & Malone, 2014). Addressing social determinants of health and health disparities: A vital direction for health and health care. 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. She is currently engaged in projects focused on the social determinants of health and the related role of the nursing profession. Email: mthornton@ndm.edu. Recommendations from the Macy Foundation Conference on preparing registered nurses for enhanced roles in primary care. Open your eyes to poverty. However, there will continue to be a need for nurses in the acute care environment who understand and assess for SDOH. 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. Citation: Thornton, M., Persaud, S., (September 30, 2018) "Preparing Today’s Nurses: Social Determinants of Health and Nursing Education" OJIN: The Online Journal of Issues in Nursing Vol. This is critical as nurses must not only have the knowledge related to SDOH, but also the confidence to influence change. This requires careful planning and tool consideration in addition to structured debriefing. Often referred to as “social determinants of health” (SDOH), these factors can drive as much as 80 percent of health outcomes. 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). Throughout her professional career, Dr. Persaud has focused on health promotion, vulnerable populations, and engaged learning. Nursing students need to develop an understanding of and ability to screen for SDOH so that they can intervene as nurses on behalf of patients. Based on the 132nd and 133rd Meetings of the NACNEP2016, Health Resources and Services Administration. (2012). Journal of Addiction Research and Therapy, 4(167). About social determinants of health. Nursing in 3D: Workforce diversity, health disparities, and social determinants of health. The focus is on collaboration and emotional support, while addressing patient priorities and planning (Oregon Primary Care Association, 2018). 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. Opportunities for curricular integration must focus on how to better educate nurses to understand the connections between SDOH and the challenges patients face. Nurse educators using poverty simulations must be careful not to perpetuate stereotypes or assumptions about poverty. Key Words: Social determinants of health, nursing education, diversity, interprofessional education, health equity, simulation, service learning. She teaches across the undergraduate and graduate nursing curricula, focusing on healthy aging and nursing theory. 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. There is no doubt that minority nurses experience slights which are related to race from unconscious bias which permeates our culture. Social determinants of health refer to the conditions people experience when they are born, grow, work and age that shape their health. Motivational interviewing and empathic inquiry can support this process and should be included in nursing curricula. Simulation can provide students with first-hand experiences that increase awareness and support the need to reconsider individual biases. The purpose of this article is to explore social determinants of health and nursing education, including clinical and classroom opportunities. The real answer is more complex. 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. Similarly, DeBonis (2015) reported an increase in graduate nursing students’ knowledge and understanding of SDOH and also a desire to continue in an advocacy role due to service learning. Health behaviour change: Advancing the utility of motivational interviewing (MI) to health promotion. Develop interprofessional education initiatives that encourage collaboration. Motivational Interviewing: Creating a leadership role for social work in the era of healthcare reform. 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. More than ever before, nursing must be ethically obligated to promote health equity in the 21st century and will require nursing care that is more acutely focused on the SDOH. 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. Registered nurses: Partners in transforming primary care. 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 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. 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. (2018). 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. Journal of Transcultural Nursing, 29(5), 473-479. doi:10.1177/1043659617753043, Buckley, S., Hensman, M., Thomas, S., Dudley, R., Nevin, G., & Coleman, J. Developing leadership and advocacy skills in medical students through service learning. 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. Describe the fundamental idea that the communicable disease chain model is designed to represent. Kamila Alexander, PhD, MPH, RN uses health equity and social justice lenses to research the prevention of sexual health outcome disparities and the complex roles that structural determinants such as intimate partner violence, societal gender expectations, and limited economic opportunities play in the experience of intimate human relationships. Online Journal of Rural Nursing & Health Care, 17(1), 73-86. doi: 10.14574/ojrnhc.v17i1.439, DeBonis, R. (2015). An effective curriculum should include multiple SDOH experiences, community engagement, and student reflection (Sabato et al, 2018). Resources within your text covering international/global health… 575 Andover Park West, Suite 101 1). 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). This method of inquiry emphasizes engaging, empathizing, supporting, summarizing/action planning, and collaborating with the team. Isolating key concepts within curricula does not enable students or nurses to see the wide-ranging influence of SDOH. Our oppor­tu­ni­ties for health start long before we need medical care. Nurses, on the frontlines of healthcare, are uniquely positioned to assess for social determinants of health and positively address health equity. This website connects you to CDC resources for SDOH data, research, tools for action, programs, and policy. Retrieved from http://www.who.int/social_determinants/sdh_definition/en/, Substance Use Disorders and Related Concerns, The 200th Birthday of Florence Nightingale, Addressing Social Determinants of Health: Progress and Opportunities, Translational Research: From Knowledge to Practice, social determinants of health and nursing education, Pruitt, Emechebe, Quast, Pamme, & Kristopher, 2018, Stanhope, Tennille, Bohrman, & Hamovitch, 2016, Appiah-Brempong, Okyere, Cross, & Adjei, 2013, National Academy of Sciences, Engineering, & Medicine, 2016, http://www.communityaction.org/povertysimulations/, https://www.ncbi.nlm.nih.gov/books/NBK395983/pdf/Bookshelf_NBK395983.pdf, https://www.orpca.org/initiatives/empathic-inquiry, https://www.bls.gov/oes/current/oes291141.htm#nat, http://www.who.int/social_determinants/sdh_definition/en/, Nurse Advocacy: Adopting a Health in All Policies Approach, Mobile Traveling Healthcare Teams: An Innovative Delivery System for Underserved Populations, Child Poverty, Toxic Stress, and Social Determinants of Health: Screening and Care Coordination, A Nurse-Led Intervention to Address Food Insecurity in Chicago. Maternal and Child Health Journal, (18)2, 431-442. doi:10.1007/s10995-013-1283-0. 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). Public Health Reports, 2014 Supplement 2(129) 19-31. Reconsideration of both curricular content and traditional acute care clinical experiences is necessary to prepare new nurses for future practice (Murray, 2017). 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. Social determinants of health describe the interaction between social, economic, and environmental factors and how they can influence a person’s health outcomes. To reduce longstanding disparities that exist in American health care, we need to address these social determinants of health. (2016). Most people do not think about health in terms of social factors. (2016). Using simulation to teach about poverty in nursing education: A review of available tools. IPE experiences among health professionals that do not tend to collaborate in actual practice can also be beneficial. Preparing nurses to address SDOH in the acute care environment and beyond is essential in today’s complex healthcare environment (Josiah Macy Jr. Foundation, 2016; National Advisory Council, 2016). Gaba, D. (2004). Empathic inquiry is an approach to conducting SDOH interviewing that is based in motivational interviewing and trauma-informed care. Nursing students need opportunities to connect didactic material with meaningful clinical experiences in a variety of settings. However, it is through the experiential learning experiences across the curriculum that increases competence and confidence of students to serve as advocates in addressing SDOH. 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. WSNA has represented nurses in our state since 1908, leveraging our collective voice to successfully advocate with employers, state agencies and the state Legislature for better working conditions, safe staffing, fair compensation and patient safety. They learned about the experience of receiving care, reaching health goals, access to resources, and motivational interviewing. For example, Sabato et al. 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. Public Health Reports, 129(Suppl 2), 32–36. 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 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. You are pointing out a very important and interesting effect of our “blindedness” to racial injustices toward our minority nurse colleagues. ... it is through the experiential learning experiences across the curriculum that increases competence and confidence of students to serve as advocates in addressing SDOH. American Association of Colleges of Nursing. (2018) found success in a formal IPE program, Team Up. Marleen Thornton, PhD, RN Surely we have been overlooking something. Educate your colleagues about how social factors lead to health disparities. Opportunities for students to reflect on the variables impacting a child’s health would be an essential component of the learning experience. Retrieved from https://www.orpca.org/initiatives/empathic-inquiry, Phillips, K., & Malone, B. Transformative changes are needed in nursing education to prepare nurses to adequately address SDOH and improve health equity. Are you aware of social service agencies around you? Retrieved from https://www.nursefamilypartnership.org/, Oregon Primary Care Association. American Nurses Association. Washington, DC: American Association of Colleges of Nursing. Traditionally, service learning has been incorporated into undergraduate nursing education. Marleen Thornton, PhD, RN Commission on the Social Determinants of Health (CSDH). Accelerated RN-to-BSN service-learning program serves the vulnerable. Acknowl­edging that health starts in our homes, schools and commu­ni­ties is the first step toward building a culture of health. doi:10.17226/21923. 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. 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). Child development is influenced by various aspects starting from birth, biology, genetic characteristics, gender, culture and family values. Healthy Families America. These threads can be easily tied to those related to SDOH. (2016). Throughout her professional and academic career, Dr. Thornton has focused on health promotion, the oldest older population, and community health. Children growing up in more deprived areas often suffer disadvantages throughout their lives, from educational attainment through to employment prospects, which in turn affe… 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. Long, J., Lee, R., Federico, S., Battaglia, C., Wong, S., & Earnest, M. (2011). 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. Students self-selected a population based on their geography, personal interest, and goals. Developing interprofessional simulation in the undergraduate setting: Experience with five different professional groups. Social determinants of health result in health inequities that often require a social justice perspective. These circum­stances are shaped by the distri­b­u­tion of money, power and resources at global, national and local levels. (2006). Are you aware of the social inequal­i­ties people are experi­encing in your commu­nity? (2008). Service Learning (2012). The Social determinants of health (SDOH) are a group of factors that impact health and wellbeing of an individual. Service learning can also successfully be integrated into nontraditional models, such as a post-licensure, online RN-BSN program. Seattle, WA 98188. LaViest, T., & Pierre, G. (2014). This perspective moves beyond gaining knowledge and encourages students to understand, reflect, analyze, and apply content to potential future experiences and encounters. So what can nurses in acute care or non-commu­nity positions do? (2013). These cir-cumstances are shaped by the distribution of money, power and resources at global, national and local lev-els” [1]. Gather Community Data With a Social Determinants of Health Questionnaire. Table. doi:10.1177/00333549141291S207, World Health Organization. Are there agencies that are working to tackle broad social issues? The WHO website lists several key concepts related to these determinants, such as employment conditions; social exclusion; public health programs and social determinants; women and gender equity; early child development; globalization; health systems; measurement and evidence; and urbanization. Social determinants of health (SDOH) are conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes. Clinical experiences within the acute care setting constitute the majority of clinical hours a pre-licensure nursing student completes. 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. Interprofessional collaboration is an often-untapped experience that provides an interesting opportunity for educators to integrate content related to SDOH into existing curricula. “In addition to inclusion in didactic coursework, experiential learning experiences are considered an effective teaching methodology for increasing awareness of SD[O]H” (Sabato et al, 2018, p 241). 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. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels” . Nurses are well positioned to help their facil­i­ties meet the Triple Aim – reduce costs, improve outcomes and improve patient experi­ence of care. Overcoming these biases is necessary to properly address SDOH. 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. Opportunities for curricular integration must focus on how to better educate nurses to understand the connections between SDOH and the challenges patients face. The social determinants of health (SDoH) have emerged as some of the most important factors influencing the health outcomes of individuals and communities worldwide. Closing the gap in a generation. 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 Reducing health inequity in the United States is a social mandate for nursing in the 21st century. To this end, we offer several recommendations. 23, No. As defined by the World Health Organization (WHO), SDoH are “the conditions in which people are born, grow, live, work and age. Factors related to health outcomes include: 1. Incorporating life course theory and social determinants of health into the LEND curriculum. Asking your patients the right questions about some social factors that affect their lives can shape more effec­tive inter­ven­tions. Leaders in the profession of nursing, and other health-related professions, must assure that appropriate content and meaningful experiences for interprofessional collaboration are incorporated into curricula to address the challenges to well-being that these multifaceted determinants present for so many. This may be helpful for program leaders to evaluate what is currently in place and where improvement is most needed. In particular, reflection offers an opportunity for both students and faculty to explore the difficult issues related to SDOH that can be uncovered through the service learning experience. Expenditure reductions associated with social service referral program. A recent longitudinal study explored baccalaureate nursing students’ knowledge and perceptions of client care as they relate to SDOH (Lee, Wilson, & Armstrong, 2018). During the first year, students focused on the critical skills needed to address SDOH on an interprofessional team. (2015). Josiah Macy Jr. Foundation. Create intentional programs of service learning. 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). Health Management nurse, you are pointing out a very important and interesting effect our! 130-140. doi:10.1016/j.profnurs.2015.10.002 commit to the development of disease people and communities assess for SDOH 55 ( )! From racial/ethnic minority groups, men, people with Disabilities, and collaborating with the knowledge related to SDOH curricula! Careful planning and tool consideration in addition to structured debriefing interesting opportunity for educators to integrate content related social! Concept that there is a need for nurses who are engaged with families community-based research sociology! Acute care setting of dental education, 56 ( 1 ), 32–36: with! 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