As a Registered Nurse working in a small-town hospital, my job was both rewarding and challenging. Getting to know patients and families by name and interacting with the local community was an enjoyable experience. However, the most considerable difficulty was finding low-cost and free community resources for the elderly, disabled, and low-income clients that could help them long-term. As nurses on the frontlines of healthcare, we can address and improve the health outcomes of all patients. This post discusses the correlation between vulnerable populations and poor health and how nurses can educate and empower patients to optimize their health.
When I started in my role as a nurse case manager, I quickly felt limited in how much I could help our sizable indigent population. Many of the preventable health issues I encountered were not just medical but widely social as well. Take, for instance, my diabetic patients who would come to the hospital repeatedly, sometimes with glucose levels so low they ended up in the intensive care unit. These clients were not merely non-compliant with their meds, as was often labeled in their charts. Instead, cultural, geographic, and environmental factors intertwined to create conditions in which diabetes (also heart disease, asthma, obesity) was more prevalent and harder to control. Many of our patients had to decide, daily, if they were going to eat a meal or get a refill of life-saving medication.
What are the Social Determinants of Health?
The Centers for Disease Control and Prevention (CDC, 2019) has defined social determinants of health (SDOH) as those “conditions in the places where people live, learn, work, play, worship, and age that affect a wide range of health risks and outcomes.” The CDC goes on to discuss how, “the contrasts in health are remarkable in communities with poor SDOH such as unstable housing, low income, no health insurance, unsafe neighborhoods, or substandard education.” (CDC, 2019).
How Social Determinants Link to Health Outcomes
Despite the advancements in medical care, health disparities continue here in the United States and around the globe. Clients with low-socioeconomic status are more likely to be found living and working in degraded areas and have higher risk factors for certain types of disease. These include physiologic factors that come from chronic stress. Moreover, this inadvertently worsens their overall health and predisposes them to shorter lifespans.
Healthy People 2020 (Office of Disease Prevention and Health Promotion [ODPHP], 2019) has developed a “place-based” organizing framework that reflects five critical areas of SDOH:
- Economic Stability
- Health and Healthcare
- Neighborhood and Environment
- Social and Community Context
To create effective programs, nurses and other healthcare professionals must work collaboratively across sectors to address the unique needs of our communities.
Examples of social determinants of health (New England Journal of Medicine, 2017):
- Income level
- Access to nutritious foods
- Access to housing and utility services
- Early childhood experiences and development
- Social support and community inclusivity
- Crime rates and exposure to violence
- Availability of transportation
- Gender inequity
- Neighborhood conditions
- Racial segregation
- Availability of safe drinking water and clean air
- Access to recreational and leisure opportunities
In tackling the social determinants of health, providers are partnering with community organizations to improve access to housing, healthy food, education, job training, transportation, and more. There are countless initiatives currently underway.
Guiding Patients Toward an Active Role in Their Care
Nurses are always working hard to help their patients in every capacity. Also, one of the essential roles of a nurse is a patient educator. Today’s nurses assume more authority for educating their patients and helping to guide them toward a more active role in their care and overall health. Additionally, this means patients need to comprehend their health status and work to prevent or minimize complications for any illnesses.
How Nurses can Improve Patient Education (NurseJournal.org, 2019) and Understanding
- Start educating patients from the moment of admission.
- Discover the patient’s knowledge level and correct any misinformation.
- Provide patient’s information in easy-to-understand, non-clinical terms.
- Make sure the patient understands the care they are receiving.
- Use return demonstration when administering care.
- Involve the patient in their care and treatment from the very beginning.
- Ask the patient how they will discuss their diagnosis with their significant other.
- Explain and build upon the teaching with every opportunity.
- Coordinate with the clinical team for continuity of care.
- Make sure the patient understands their medications.
- Reiterate the actions and side effects of their meds. Give details on how the medications will help them to control their disease and what outcomes to expect.
- Give the patient specifics on how and when to refill medications?
- Provide patients with information about signs and symptoms to report to the physician.
- Provide the discharge instructions and meds and thoroughly review with patient and family members or care providers.
- Provide the patient with a follow-up appointment with their physician.
- Provide the patient with a list of all services and phone numbers for local community resources
- Remember to call the patient within 24 hours after discharge to follow-up and make sure they don’t have any problems or questions.
Finally, to address health outcomes associated with social determinants of health, nurses and other health care providers must promote good health by providing preventative guidance, helpful community resources information, correct treatment plans, and continuous advocating for local, state, and federal policies that will, one day, minimize societal inequities.