“You only have time for so much in 12 hours” unmet social needs of hospitalised patients: A qualitative study of acute care nurses

Abstract

Aims and objectives To explore the experiences of nurses caring for socially at‐risk patients and gain an understanding of the challenges nurses face when providing care. Background Nurses play a pivotal role in caring for hospitalised patients with social risk factors and preparing them for discharge. Few studies have explored whether acute care nurses are adequately supported in their practice environments to address the unique needs of socially at‐risk patients as they transition back into community settings. Design A qualitative descriptive study of nurses working in a large urban academic medical centre. Methods We conducted six semi‐structured focus groups of nurses (n = 21). Thematic content analysis was performed to analyse the transcripts from the focus groups. We adhered to COREQ guidelines for reporting this qualitative study. Results Six key themes emerged: (a) nurses’ assessments of social risk factors, (b) experiences providing care, (c) barriers to care, (d) fear of “labelling” socially at‐risk patients, (e) unmet social care needs and (f) recommendations to improve care. Conclusions Our findings suggest that nurses are able to identify social risk factors. However, prioritisation of medical needs during acute care hospitalisation and lack of organisational supports may deter nurses from fully addressing social concerns. Relevance to clinical practice Acute care nurses should be involved in the development of future efforts to address the needs of socially at‐risk patients and be provided with additional supports in their practice environments. This could include continuing education to build nursing competencies in community‐based care and social vulnerability.

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

“…As previously noted, few studies have captured nurses’ knowledge, confidence, and behaviors relative to our topic. Regarding identified barriers, similar results have been noted elsewhere (Anderman & CLEAR Collaboration, 2016; Brooks Carthan et al, 2019; Tellon, Kendall, Priddis, Newall, & Young, 2017). In a review of the literature, Anderman & CLEAR Collaboration (2016) noted provider time constraints, lack of perceived self‐efficacy about integrating the determinants of health into practice, as well as unfamiliarity with referral resources as barriers to integrating the determinants of health into practice for providers and allied health workers, including nurses.…”

“…In a review of the literature, Anderman & CLEAR Collaboration (2016) noted provider time constraints, lack of perceived self‐efficacy about integrating the determinants of health into practice, as well as unfamiliarity with referral resources as barriers to integrating the determinants of health into practice for providers and allied health workers, including nurses. Brooks Carthan et al (2019), in their qualitative study with 21 nurses employed in a single hospital setting, noted time constraints and identified knowledge gaps regarding available community resources and variations in social support across units as barriers to fully addressing the social needs of patients. In an integrative review of the literature, Tellon et al (2017) reported lack of provider confidence in addressing the psychosocial needs of pediatric patients and the over reliance on the medical model as barriers to integrating the SDoH into pediatric practice.…”

“…In an integrative review of the literature, Tellon et al (2017) reported lack of provider confidence in addressing the psychosocial needs of pediatric patients and the over reliance on the medical model as barriers to integrating the SDoH into pediatric practice. Provider education, resource training, and skill development in communication are potential strategies to overcome these barriers (Anderman & CLEAR Collaboration, 2016; Brooks Carthan et al, 2019; Tellon et al, 2017).…”

“…Findings suggest that care must be taken not to overburden nurses with the responsibility of addressing the needs of socially at‐risk patients. Although nurses have the skill to be engaged in this endeavor, nursing workflow and the traditional clinical role of nurses may need to be changed if nurses are to become more engaged in caring for patients with unmet social needs (Brooks Carthon, Hedgeland, Brom, Hounsell & Cacchione, 2019).…”

Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives

“…As has been identified in hospital settings, clinicians are more likely to put clinical priorities first before nonclinical interventions. 7 Task shifting to the patient navigator may reflect efforts by clinicians to meet patients’ needs as effectively as possible. CHC leaders should be prepared to assign patient navigators or other staff to support the referral process as part of their formal duties.…”