Integrating the Social Determinants of Health into Nursing Practice: Nurses' Perspectives

Abstract

Purpose The purpose of this study was to assess nurses’ knowledge, perceived self‐efficacy, and intended behaviors relative to integrating the social determinants of health (SDoH) into clinical practice. Design and Methods A cross‐sectional study was completed with 768 nurses working in three hospitals within a large regional healthcare system located in the Midwest. Data were collected using an adapted 71‐item SDoH Survey, which measured nurses’ confidence in and frequency of discussing the SDoH with patients, general knowledge of the SDoH, familiarity with patients’ social and economic conditions, and awareness of their institution’s health equity strategic plan to achieve health equity. The institution’s health equity strategic plan reflects the organization’s commitment to improving the health of individuals and neighborhoods by addressing the SDoH known to influence health status and life expectancy. Finally, participants were asked to describe barriers to incorporating the SDoH into practice along with completing five demographic items. Descriptive statistics were used to describe the findings. Findings Of the 768 respondents, 63% had a baccalaureate degree in nursing and 33.1% reported more than 20 years in nursing. Fifty percent of respondents reported feeling more knowledgeable or confident in their ability to discuss access to care issues with patients compared to the other SDoH. Identified barriers to discussing the SDoH included insufficient time to address identified needs and unfamiliarity with internal and external resources. Respondents stressed the need for interdisciplinary education and collaboration along with more information on the role of social workers. Conclusions Nurses are more confident in discussing certain determinants of health and could benefit from more skill development in discussing SDoH issues and stronger collaborative partnerships to address identified needs. Clinical Relevance Findings from the study have implications for supporting the educational and resource needs of front‐line nurses employed in hospitals and health systems seeking to address broader societal issues influencing the health status and outcomes of patients and communities.

Nurses’ perceptions: Addressing social determinants of health to improve patient outcomes

“…Nurses in this study identified multidisciplinary advocacy as necessary to change the health-care system 33 and this was also found in the survey study of how nurses integrate SDOH into their practice. 26 The nurses in this study did not mention that they, themselves, should join task forces or become members of organizations that advocate for health change. Berwick 34 proposes that nurses have a moral obligation to not just ensuring care for patients with illness and disease, but changing the structural issues of society that affect health, such as the SDOH.…”

“…11,25 A survey study of nurses working in acute care hospitals found that the nurses were more comfortable talking with patients about health care access than other SDOH and that the nurses' lack of knowledge of resources made them less able to meet patients' needs. 26 The nurses in this qualitative study voiced that just providing resources did not always improve care. The participants noted that patients needed to be ready for change as well as have the ability to use the resources, and nurses needed to meet the patient where they were at.…”

Global inequity in nursing education: a call to action

“…The evidence continues to suggest that nurses will require commitments to interdisciplinary training and collaboration, as well as further skill development regarding the social determinants, in order to effectively address the broader societal issues influencing health outcomes as both clinicians and advocates. 86 Box 6: Case study: the 2020 Nightingale Challenge 87 The purpose of the 2020 Nightingale Challenge is to help develop the next generation of young nurses and midwives as leaders, practitioners and advocates in health and to demonstrate both are rewarding careers.…”

Intersecting systemic and personal barriers to accessing social services: qualitative interviews in northern California

“…For example, the American Hospital Association has laid out barriers to ensuring access to quality healthcare in vulnerable communities, including “limited federal funding, restrictive federal regulations, and a lack of collaboration and buy-in from community stakeholders” and indicates that “the most important resource may be hospital-community partnerships” [ 6 ]. Furthermore, disconnected relationships have been identified and described between clinical-community partnerships [ 7 ], and collaborative clinical-community partnerships are required to address patient social needs [ 8 ]. More work needs to be conducted to identify and describe barriers to accessing social needs-related services, especially when those needs are identified in a healthcare setting.…”