Chapter Three: Social Determinants of Health and Vulnerable Populations
Practical Application: Book Activity
Practical Application
Setting the Scene
Healthcare Disparities: Sharlene Adams Goes to Buy a Blood Pressure Cuff
Watch the video at https://youtu.be/d6wH4nQVmhw
Think About It
Consider Sharlene’s experience as showcased in the video.
- What factors did you notice that either contributed to or reduced Sharlene’s overall health?
- Of the factors you identified, how many are considered social determinants of health?
- What changes could the physician’s office make to make healthcare more accessible to Sharlene?
- What were the transportation barriers Sharlene experienced? Do you think this will reduce her health-seeking behaviors in the future? For example, future health screenings?
- What state or national policies can you identify that would contribute to or present barriers to Sharlene’s health if she lived in your neighborhood?
Practical Application: Additional Guidance
Exercise Title
Addressing Healthcare Disparities
Objective
This exercise aims to engage nursing students in critical analysis of healthcare disparities through the lens of a patient’s experience, with a focus on identifying social determinants of health and exploring potential interventions and policy implications.
Preparing for the Exercise
- Introduction: Introduce the scenario of Sharlene’s experience as showcased in the video, emphasizing the challenges she faced in accessing healthcare and the potential impact on her overall health outcomes. Introduce students to the concept of upstream vs. downstream actions.
- Video Viewing: Direct students to watch the provided video on healthcare disparities or access it through the provided QR code. Encourage active observation and note-taking.
Exercise Components:
- Analysis of Factors: Prompt students to identify factors that either contributed to or reduced Sharlene’s overall health based on her experience in the video. Encourage them to consider social, economic, cultural, and environmental determinants of health.
- Identification of Social Determinants: Guide students in identifying which of the factors they identified are considered social determinants of health, such as access to healthcare, socioeconomic status, education level, transportation, and social support networks.
- Proposed Interventions: Challenge students to propose changes that the physician’s office could make to improve healthcare accessibility for patients like Sharlene. Encourage them to consider strategies such as expanding clinic hours, providing transportation assistance, offering language interpretation services, and implementing culturally sensitive care practices.
- Transportation Barriers: Facilitate a discussion on the transportation barriers that Sharlene experienced and their potential impact on her health-seeking behaviors, including future health screenings. Encourage students to consider the role of transportation infrastructure, affordability, and accessibility in healthcare access.
- Policy Implications: Prompt students to identify state or national policies that could either contribute to or present barriers to Sharlene’s health if she lived in their neighborhood. Encourage them to consider healthcare coverage policies, transportation policies, funding for community health programs, and initiatives addressing social determinants of health.
Evaluation and Assessment
- Critical Analysis: Assess students’ ability to critically analyze Sharlene’s experience and identify relevant social determinants of health, healthcare access barriers, and potential interventions.
- Engagement in Discussion: Evaluate students’ active participation in discussions, including their contributions to identifying factors, proposing interventions, and discussing policy implications. Consider having students write a 1 minute essay of their reflections that can be submitted as a participation grade.
Integration into Curriculum
- Alignment with Course Objectives: Ensure that the exercise aligns with course objectives related to community health nursing, health disparities, social determinants of health, and healthcare policy.
- Sequencing: Determine the appropriate timing and sequencing of the exercise within the course curriculum to complement other content and activities.
- Integration of Theory and Practice: Emphasize the application of nursing theory and evidence-based practice to real-world scenarios, fostering the development of culturally competent and socially conscious nursing practice.
Resources and Support
- Learning Resources: Provide students with access to relevant literature, articles, and resources on healthcare disparities, social determinants of health, and healthcare policy.
- Faculty Support: Offer guidance, feedback, and support to students as they engage in the exercise, addressing any questions or concerns they may have about the scenario or related topics.
Conclusion
By following these guidelines, nurse educators can facilitate a meaningful and impactful practical application exercise that challenges nursing students to critically analyze healthcare disparities, identify social determinants of health, and explore potential interventions and policy implications for promoting health equity.
Additional Activities
Role-playing/Communication Exercise
Scenario Title
Home Visit with a Vulnerable Patient
Objective
To enhance students’ communication skills and cultural competence when conducting home visits with vulnerable patients, considering the impact of social determinants of health on health outcomes.
Learning Outcomes
- Develop effective communication skills in conducting home visits with vulnerable populations.
- Identify social determinants of health and their impact on health outcomes.
- Strengthen cultural competence and sensitivity in addressing diverse patients’ unique needs and preferences.
- Create care plans that promote health equity and address social determinants of health.
Preparation
- Divide students into pairs, with one student playing the role of the nurse and the other playing the role of a vulnerable patient.
- Provide each pair with a brief background scenario detailing the patient’s socio-economic status, health concerns, and social determinants of health influencing their health outcomes.
Role-Playing Activity
- Preparation
- The nurse prepares for a home visit to assess the patient’s health status and living conditions.
- The patient prepares to welcome the nurse into their home and discuss their health concerns and needs.
- Home Visit
- The nurse conducts the home visit, introducing themselves respectfully and explaining the purpose of the visit.
- The patient welcomes the nurse into their home and shares information about their living situation, family dynamics, and health challenges.
- Assessment and Communication
- The nurse assesses the patient’s health status, including vital signs, medication adherence, and any symptoms or concerns.
- The patient expresses their health concerns, highlighting the impact of social determinants such as housing instability, food insecurity, or lack of access to healthcare.
- Cultural Competence and Sensitivity
- The nurse demonstrates cultural competence and sensitivity by respecting the patient’s cultural beliefs, values, and practices.
- The patient appreciates the nurse’s willingness to listen and understand their cultural background and experiences.
- Care Planning and Resources
- The nurse collaborates with the patient to develop a care plan that addresses their health needs and social determinants of health.
- The patient expresses gratitude for the nurse’s support and advocacy and agrees to follow the care plan and utilize available resources.
Debriefing and Feedback
After the role-play, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- Students can discuss their communication strategies, cultural competence skills, and areas for improvement in conducting home visits with vulnerable populations.
- Possible questions:
- How did you adapt your communication style to effectively engage with the patient?
- What social determinants of health did you identify during the home visit, and how did they impact the patient’s health outcomes?
- How did you demonstrate cultural competence and sensitivity in your interactions with the patient?
- What resources and support did you provide to address the patient’s health needs and social determinants of health?
- What did you learn from this role-playing exercise, and how will it inform your nursing practice when working with vulnerable populations?
Reflective Practice
This activity could occur on a discussion board or by uploading a video using Flip or Canvas Studio.
How have you observed social determinants of health influencing the health outcomes and healthcare experiences of vulnerable populations? How do factors such as income, education, housing, and access to healthcare resources affect the health of individuals and communities? Furthermore, how does understanding social determinants of health influence your approach to patient care and advocacy for vulnerable populations within the healthcare system?
Interactive Module
Create an interactive escape room using Google Forms that challenges students to solve puzzles related to the chapter topic. These NCLEX-style questions can be a starting point.
- A community health nurse is conducting a needs assessment in a low-income neighborhood. Which social determinant of health is most likely to contribute to health disparities in this population?
- Availability of public transportation.
- Proximity to recreational facilities.
- Access to affordable housing.
- Presence of fast food restaurants.
- A nurse is caring for an unhoused individual in the emergency department. Which social determinant of health should the nurse prioritize when developing a plan of care for this patient?
- Employment status.
- Educational level.
- Stable housing.
- Access to healthcare services.
- A nurse is providing discharge instructions to a patient with limited health literacy. Which social determinant of health is the nurse addressing by using plain language and visual aids?
- Employment status.
- Income level.
- Educational attainment.
- Neighborhood safety.
- A pregnant teenager from a low-income family presents to the clinic for prenatal care. Which social determinant of health is most likely to impact the health outcomes of both the mother and the baby?
- Access to transportation.
- Maternal education level.
- Availability of fresh produce.
- Proximity to healthcare facilities.
- A community health nurse is planning a health promotion program for seniors living in low-income housing. Which social determinant of health should the nurse prioritize to improve the health outcomes of this population?
- Availability of social support networks.
- Proximity to grocery stores.
- Access to public transportation.
- Availability of recreational facilities.
Case Study: Addressing Social Determinants of Health in the Unhoused Population
Background
The student is a community health nurse working in an urban area with a high unhoused population. Many individuals experiencing a housing crisis face multiple social determinants of health, including housing instability, food insecurity, substance use, and limited access to healthcare services. The lack of stable housing exacerbates their vulnerability and contributes to poor health outcomes.
Scenario
Megan presents to the community health clinic with complaints of chronic pain and difficulty sleeping. She reports feeling hopeless and isolated, attributing her symptoms to her living situation and lack of access to healthcare. During the assessment, you observe signs of malnutrition and unmanaged chronic conditions. Megan expresses a desire to improve her health but feels overwhelmed by her circumstances.
Questions for Reflection and Analysis
- Identifying Social Determinants of Health
- What social determinants of health are evident in Megan’s case, and how do they contribute to her health challenges and vulnerability?
- Impact on Health Outcomes
- How do social determinants such as housing instability, substance use, and limited access to healthcare services impact Megan’s physical and mental health outcomes?
- Health Promotion Strategies
- What health promotion strategies can be implemented to address Megan’s immediate health needs and social determinants of health?
- Interdisciplinary Collaboration
- How can interdisciplinary collaboration with social workers, mental health professionals, and community organizations support Megan in addressing her social determinants of health and improving her overall well-being?
- Barriers to Care
- Identify specific barriers that Megan faces in accessing healthcare services and adhering to treatment plans. How can these barriers be addressed to facilitate better health outcomes for Megan?
- Cultural Competence and Sensitivity
- How can you demonstrate cultural competence and sensitivity in providing care to Megan, considering her unique background and experiences as someone who is unhoused?
- Advocacy and Empowerment
- What role can nurses play in advocating for policy changes and healthcare initiatives to address social determinants of health and improve outcomes for vulnerable populations like Megan’s?
Case Study Follow-up
After discussing the case study questions, students can develop a comprehensive care plan for Megan, considering her unique needs, challenges, and social determinants of health. They can explore community resources and support services to address Megan’s immediate health concerns and work collaboratively to address the root causes of her vulnerabilities.
Simulation
Scenario
Vulnerable Populations
Objective
Provide nursing students with a simulated experience as community health nurses working with vulnerable populations. This will allow students to apply their knowledge and skills in providing holistic care, addressing social determinants of health, and promoting health equity.
Learning Outcomes
- Apply nursing knowledge and skills in providing holistic care to vulnerable populations in community settings.
- Identify and address social determinants of health that impact the health outcomes of vulnerable clients.
- Enhance communication, cultural competence, and advocacy skills when working with diverse populations.
- Collaborate with interdisciplinary teams and community resources to promote health equity and improve the well-being of vulnerable individuals and communities.
Roles
- Nurse
Preparation
- Set up simulated community environments such as a local clinic, community center, shelter, or senior living facility.
- Provide realistic props and materials (e.g., medical equipment, client charts, community resources pamphlets) to enhance the authenticity of the simulation.
- Divide students into small groups and assign roles such as community nurse, client, family member, social worker, etc.
- Provide each group with a brief background scenario detailing the vulnerable population they will work with (e.g., unhoused individuals, elderly residents in low-income housing, undocumented immigrants).
Simulation Outline
- Each group participates in the exercise that simulates a community nursing encounter with their assigned vulnerable population.
- Students interact with each other in their assigned roles, addressing the unique needs, challenges, and social determinants of health affecting their clients.
- Example:
- Students role-play community nurses conducting home visits to elderly residents living alone in low-income housing. They assess the client’s (this could be an SP, a student serving as the SP, or mannequin) health status, living conditions, and social support networks while addressing issues such as isolation, food insecurity, and access to healthcare.
Debriefing and Feedback
After the simulation, conduct a debriefing session where each participant reflects on their experience, provides feedback, and discusses lessons learned.
- Encourage students to explore the challenges of providing community nursing care to vulnerable populations, strategies for addressing social determinants of health, and the importance of promoting health equity and advocacy in their practice.
Competency Assessment
Activity
Develop and implement interventions that address social determinants and promote health equity.
Demonstration
Students can demonstrate competency by collaborating with interdisciplinary teams to address social determinants, providing patient education on self-care and resources, and advocating for policy changes to improve health equity.
Clinical Activities/Opportunities
- Students can participate with interdisciplinary care teams in hospitals or clinics that serve diverse patient populations, including individuals with complex health and social needs. Students can participate in care coordination efforts, case conferences, and collaborative care planning to address social determinants and promote health equity.
- Form clinical partnerships in underserved areas, such as urban clinics, rural health centers, or migrant health clinics, where students can work directly with vulnerable populations.
