The full text of this NLN Vision is online:
http://www.nln.org/about/position-statements/nln-living-documents
The National League for Nursing (NLN) believes that the social determinants of health (SDH), the conditions in which people live and work - for example, lack of income, inappropriate housing, unsafe workplaces, and scarcity of access to health systems - lead to inequalities within and between countries (World Health Organization Commission on Social Determinants of Health, 2008), shape health in powerful ways, and must be an essential component of health professions education (National Academies of Sciences, Engineering, and Medicine, 2016). Currently, the SDH are not well integrated into undergraduate and graduate nursing education (Tilden, Cox, Moore, & Naylor, 2018). As a result, the emerging nursing workforce may not be prepared to assess SDH; assist patients, families, and communities to make the choices that lead to good health; and fully appreciate the impact of SDH on health, social justice, and health equity. In the context of [its] core values, the NLN maintains that to limit attention to the SDH discounts the most fundamental assumptions about nursing, the nurse's responsibility to safe, high-quality care, and nursing's unwavering commitment to health equity and reduction of health disparities.
Nurse educators, teaching in both graduate and undergraduate programs, are faced with the urgent need to design curricula that provide a better understanding of the root causes that contribute to an individual's health, the reasons health disparities exist, and how health equity is achieved by all people regardless of socioeconomic status. Such an undertaking would be a commitment to nursing's social mission to advocate for social justice and health equity. Nurse educators have a responsibly to assist students to reframe their understanding of the SDH, recognizing that bias and stigmatization contribute to health disparities and that health issues related to the SDH are not a choice, but rather the direct result of exposure to disparate financial, social, and environmental conditions.
RECOMMENDATIONS FOR FACULTY
* Utilize the NLN toolkit (http://www.nln.org/docs/default-source/professional-development-programs/ace-ser) to provide evidence-based approaches to teaching/learning strategies related to the SDH.
* Raise students' consciousness about SDH, how to develop an inclusive understanding of the SDH, and how recognizing [its] shared impact on health and wellness leads to new perspectives related to differences and mitigates bias and racism.
* Create partnerships with community agencies to provide experiences that intentionally expose students to address the impact of SDH on patients, families, and communities.
* Thread SDH education throughout the program of learning in varied educational settings [and] be intentional about providing opportunities for students to assess and implement actions to address SDH in a variety of settings.
RECOMMENDATIONS FOR LEADERSHIP IN NURSING PROGRAMS
* Engage faculty and staff in conversations directed toward addressing explicit and implicit bias related to SDH to foster a more inclusive understanding of the SDH and their effects on health and wellness.
* Encourage faculty to co-create new narratives around health and wellness.
* Provide faculty development opportunities to prepare faculty to co-create and implement educational experiences related to assessment and intervention to decrease the impact of SDH.
* Maximize educational capacity by establishing partnerships with practice colleagues and the community around innovative curriculum design to build collaborative initiatives that address SDH.
RECOMMENDATIONS FOR THE NLN
* Provide professional development programs to prepare faculty to integrate SDH content and learning experiences across the curriculum in a wide variety of practice settings. Develop faculty resources and model curricula for undergraduate and graduate programs to intentionally integrate the SDH.
* Support research for intervention, replication, and multisite studies to identify best practices and evidence-based strategies to foster and sustain the SDH in academic environments and to determine outcomes related to the integration of the SDH in schools and nursing.
* Work with policy makers and leading national and international organizations to foster a greater understanding of SDH and their significant impact on health outcomes, health equity, and social justice.
REFERENCES