Addressing Social Determinants of Health in Nursing Practice

Background: Social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age (WHO, 2016). These important characteristics of the human experience are receiving increased global attention due to their influence on health, disparities, and quality of life. There is a need for education, awareness and policy development to address the causes of these characteristics on multiple levels(Braveman & Gottlieb, 2014). The special skills nurses possess as patient advocates position them to lead initiatives that address the social determinants of health and related health disparities in the populations they serve (Lathrop, 2013). The connections nurses develop and maintain with those they are called to serve place them in the ideal space to develop and implement interventions that address SDOH and their related health disparities. In order to effectively do so, nurses must develop a comprehensive understanding of the SDOH and a specific set of skills to address these issues in practice. The purpose of this study was to explore nurses knowledge, attitudes, and beliefs related to Social Determinants of Health.

Methods: The following research questions were addressed in this exploratory descriptive study: What is the level of knowledge, attitudes, and beliefs related to SDOH among practicing nurses? What are the barriers to addressing SDOH in nursing practice?

A convenience sample of 107 registered nurses enrolled in a community health course in a RN-BSN program participated in this study. Participants completed the 40 item Social Determinants of Health Survey (𝝰= .83) (Klein, Kahn, Baker, Fink, Parrish, & White, 2011). Data were entered and analyzed in SPSS V22.

Results: Participants reported high levels of knowledge, confidence and likelihood to discuss the SDOH of social support, stress, addiction and transportation. All of the participants identified that nurses should be involved in addressing issues related to SDOH in practice.

However, they reported low levels of knowledge, confidence and likelihood to discuss social gradient, food insecurity, social exclusion/inclusion, and unemployment and job security. Data revealed that the participant’s own discomfort, anticipated patient discomfort, a lack of skill and time, and a dependency on other professionals to address these issues prevented them from adequately addressing the SDOH in their practice.

Implications: The project revealed the pressing need for increased awareness of and knowledge about the social determinants of health for registered nurses. Findings suggest that nurses believe this is part of nursing practice but lack the skills necessary to develop and lead innovative initiatives that address SDOH in the current fast-paced practice environment. While a model suggesting how nurse practitioners can intervene on the social determinants of health has been proposed (Davis & Chapa, 2015), additional attention must also be placed on the over 3 million registered nurses practicing throughout the United States . Nurse educators in both academic and clinical practice settings have an opportunity to integrate this important content into nursing curricula and continuing education. In order for nurses to be leaders in improving health disparities, immediate attention to this pressing issue is required within nursing research, education, and practice.