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Supporting Nurses to Address the Social Determinants of Health

Nurses need access to adequate education, ample care team members, and community-based resources to address the social determinants of health.

Nurses are essential figures on the frontlines of patient care, being highly regarded for fostering strong patient relationships and driving a quality patient experience. So naturally, this puts nurses in a good position to address the social determinants of health.

The social determinants of health (SDOH), have been increasing in prominence over the past several years, especially as medical professionals continue to embrace value-based care models. The SDOH have downstream health impacts that not only affect patient well-being and health equity, but healthcare spending as well.

Industry experts maintain that addressing the SDOH is critical for driving quality patient care while tamping down on healthcare expenditures.

And nurses are at the frontlines of doing so, Ellen F. Olschansky, PhD, RN, WHNP-BC, FAAN, wrote in an American Journal of Nursing article.

“Nursing has always had a strong focus on SDH,” she wrote. “Florence Nightingale emphasized the importance of hygiene, nutrition, social network, and social class. Lillian Wald, the founder of public health nursing, established the Henry Street Settlement, out of which developed the Visiting Nurse Service of New York, which provides health care to the poor. The Code of Ethics for Nurses of the American Nurses Association includes principles of social justice and emphasizes the need to integrate social concerns into nursing and health policy.”

But that does not mean nurses don’t need help, Susan B. Hassmiller, senior scholar-in-residence and senior adviser to the President on Nursing at the National Academy of Medicine, wrote in a 2019 Health Affairs post.

“At nearly 4 million people strong, nurses in the United States are perfectly positioned to do just that—but they need the resources to address the social determinants of health,” Hassmiller explained. “They say in the report that they want to address the social determinants of health, but they cannot do it alone.”

In order for nurses to fulfill their potential addressing the social determinants of health, they must receive adequate education about the SDOH, benefit from a strong team-based care approach, and have access to ample community-based resources to which they may refer their patients in need.

Education about SDOH, screening

Foremost, nurses need adequate medical education about the social determinants of health, including what they are, how they may lead to health complications, how they impact healthcare costs, and how to screen patients.

In doing so, organization leaders can emphasize the importance of nurses discussing the social determinants of health with patients.

However, simply discussing the SDOH during nurse training will not be enough, according to a paper published in the Online Journal of Issues in Nursing.

“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,” the researchers said, citing past studies. “Integration of SDOH content into nursing curricula is preferably approached from a transformative learning standpoint. This perspective moves beyond gaining knowledge and encourages students to understand, reflect, analyze, and apply content to potential future experiences and encounters.”

Experts also recommend nurses receive education about using empathy while discussing social determinants of health with patients, a key skill that nurses can develop during medical simulations. The simulation approach can help nurses put their didactic knowledge about SDOH to work and develop a greater understanding about a specific SDOH.

Finally, medical educators and clinical leaders may consider teaching SDOH in the context of team-based care. Nurses can gain experience addressing SDOH alongside their colleagues, ideally those with diverse medical expertise, helping them to bring team-based care into their professional practice, the OJIN paper explained.

Adequate staffing, workforce support

Of course, addressing the social determinants of health can be a significant undertaking that presents a workflow challenge for nurses balancing a number of other clinical duties. Although nurses acknowledge the importance of SDOH and recognize the role they play in uncovering them, nurses cannot go it alone.

“Nurses should work as part of interprofessional teams that include social workers, community health workers, physicians, and allied health professionals to help to address health inequities and the social determinants of health,” Hassmiller wrote in her Health Affairs post. “Institutions should fully garner nurses’ potential and work with them to discover new ways of addressing individuals’ unmet needs.”

While nurses are on the frontlines of patient care and are critical drivers of patient communications, they must acknowledge where they must delegate SDOH duties. Nurses are poised to form relationships with patients, which puts them in a good position to understand a patient’s social needs. And while nurses might have some knowledge about coordinating healthcare with those social needs, they must lean on the expertise of case workers and other community health workers to make those connections for patients.

“We're seeing an uptick in organizations using community health workers, and the role itself has been codified by the fact that the Department of Labor now tracks community health workers,” said Kelly Aiken, vice president of programs at the National Fund for Workforce Solutions and its medical workforce initiative CareerSTAT.

“There is some movement on reimbursement for community worker services,” she continued. “Increasingly, we're seeing providers wanting to create more structure and defined competencies for what a community health worker is and does.”

Placing an emphasis on team-based care and collaboration – especially during the medical education process – can empower nurses to foster relationships with community health workers and other key partners.

Ample community health resources, partnerships

Finally, nurses – and their care teammates – need actual resources to which they can refer their patients for community health and social needs. Without such resources, which are usually hosted through community health partnerships between hospitals and social services organizations, nurses cannot adequately address social needs, Olshanksy argued in her AJN post.

Organization leaders must ensure nurses have adequate information about these community resources, however. Specifically, leadership must ensure nurses know the requirements that can qualify a patient for a certain social service; whether the patient has extenuating circumstances that would make a social service out of reach; and whether a certain service has specific hours of operation.

Sending a patient to a certain service that fails to deliver on a nurse or clinician promise can lead to lapses in patient trust and considerably hinder SDOH efforts, experts agree.

As the medical industry continues to prioritize value-based care principles, the social determinants of health will remain prominent, and it will take a team effort to address them. Nurses, who are widely regarded as leaders in patient-centricity and relationship-building, are in key positions to adequately identify and address social risk factors.

To best equip nurses for that responsibility, the medical industry must ensure nurses receive the right training, adequate workforce support, and social services resources to truly help patients.

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